Improvement of muscle strength in osteoarthritic knee patients after intraarticular knee injection of hyaluronan

OBJECTIVE: The objective of this study was to investigate whether the knee concentric and eccentric muscle strengths can be improved in patients with bilateral knee osteoarthritis after intraarticular hyaluronan injections. DESIGN: A total of 25 patients with bilateral knee osteoarthritis and with a radiographic Ahlb?ck grading scale of I or II participated in this study. One session of intraarticular knee injection of hyaluronan was given to both knees (weekly intraarticular knee hyaluronan injections for a total of 5 wks). Knee concentric and eccentric muscle strengths were recorded between 10 and 90 degrees of knee flexion. The recordings were done on two angular velocities, 80 and 240 degrees/sec. This study took place in a tertiary medical center with a gait laboratory and a KIN-COM isokinetic dynamometer. RESULTS: An increase in concentric and eccentric muscle strength adjusted for body weight (P < 0.01) was observed in both knees, ranging between 5.1% and 27.7%. CONCLUSION: The decreased knee muscle contraction strength (concentric and eccentric) can be improved in knee osteoarthritis patients with an Ahlb?ck grading scale of I or II after five weekly intraarticular knee injections of hyaluronan.     

Sagittal plane loading response during gait in different age groups and in people with knee osteoarthritis

OBJECTIVE: To investigate the gait patterns and the sagittal ground reaction forces in different age groups and in people with knee osteoarthritis. DESIGN: Motion analysis and force platform data were collected for a total of 55 female subjects capable of independent ambulation. Subjects were divided into three groups consisting of the control group, the elderly group, and the osteoarthritis knee group. Gait parameters of walking velocity, cadence, step length, stride time, single- and double-support time, and sagittal ground reaction forces were obtained during comfortable walking speed. Gait analysis was performed in a tertiary hospital's gait laboratory. Variables were analyzed using a univariate repeated-measures analysis of variance. Statistical significance was set at a value of P < 0.05. RESULTS: The osteoarthritis knee group had slower walking velocity, lower cadence, and longer stride time as compared with the elderly and young control groups (P < 0.05). In ground reaction force studies, the first peak time, expressed in percentage of gait cycle, was significantly longer in the osteoarthritis knee group (20.8 +/- 3.2) as compared with the elderly (17.8 +/- 2.0) and young control groups (17.1 +/- 1.8, P < 0.01). The force during time of minimal midstance was larger in the osteoarthritis knee group (90.9 +/- 5.3) as compared with the elderly and young control groups (P < 0.05). The second peak force was significantly smaller in the osteoarthritis knee group as compared with the young control group (P < 0.01). The force change in the midfoot region in the osteoarthritis knee and elderly groups revealed more loading force onto the midfoot region during midstance as compared with the young control group (P < 0.01). CONCLUSION: Gait parameters in the elderly and osteoarthritis knee patients were characterized by slower walking velocity, lower cadence, shorter step length, longer stride time, and longer double-support time. Less heel contact and push-off forces were noticed in these two groups, with more loading force onto the midfoot during midstance.     

Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain

OBJECTIVE: To assess the efficacy and safety of intra-articular injections of sodium hyaluronate combined with a home exercise program (HEP) in the management of pain associated with osteoarthritis (OA) of the knee. DESIGN: Single-blinded, parallel-design, 1-year clinical study with sequential enrollment. SETTING: University-based outpatient physiatric practice. PARTICIPANTS: Sixty patients (18 men, 42 women; age, > or =50 y) with moderate-to-severe pain associated with OA of the knee. INTERVENTIONS: (1) Five weekly intra-articular hyaluronate injections (5-HYL); (2) 3 weekly intra-articular hyaluronate injections (3-HYL); or (3) a combination of an HEP with 3 weekly intra-articular hyaluronate injections (3-HYL+HEP). MAIN OUTCOME MEASURES: The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24 m). Secondary measures included the Western Ontario and McMaster Universities Osteoarthritis Index subscales. RESULTS: The 3-HYL+HEP group had significantly faster onset of pain relief compared with the 3-HYL (P<.01) and 5-HYL groups (P=.01). All groups showed a mean symptomatic improvement from baseline (reduction in baseline pain at 3 mo was 59%, 49%, and 48% for the 3-HYL+HEP, 3-HYL, and 5-HYL groups, respectively) that was clinically and statistically significant. There were no between-group differences in the incidence or nature of adverse events. CONCLUSIONS: The combined use of hyaluronate injections with HEP should be considered for management of moderate-to-severe pain in patients with knee OA.     

关节腔加压灌洗治疗重度膝骨关节炎临床效果观察

目的 探讨关节腔加压灌洗治疗重度膝骨关节炎炎性积液的疗效和安全性.方法 重度膝骨关节炎积液患者117例(137膝),按积液量分为治疗组61例(69膝),对照组56例(68膝).两组均第1周给以复方倍他米松,第2～6周注射玻璃酸钠,共6周为1疗程.治疗组在注射玻璃酸钠前加用关节腔加压灌洗.参照Lequesne骨关节炎评估法制定观察表,记录治疗前后积液量、疼痛、功能评分及不良反应.结果 117例患者均完成治疗,治疗组在关节积液量、疼痛和功能评定上明显优于对照组(P ＜ 0.05).结论 关节腔加压灌洗治疗重度膝骨关节炎炎性积液的疗效明显优于不进行加压灌洗治疗,无明显不良反应.     

Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis

OBJECTIVE: To determine if compensatory actions take place at the pelvis and other joints of the affected lower limb in subjects who were in an early stage of hip osteoarthritis (OA). DESIGN: Nonrandomized, case-control study. SETTING: A gait laboratory. PARTICIPANTS: Seventeen patients with OA of the hip (clinical group) matched with 17 healthy elderly subjects (nonclinical group). INTERVENTIONS: Video data obtained while subjects walked a 10-meter walkway twice and stepped across a forceplate. MAIN OUTCOME MEASURES: Four phasic and temporal gait parameters (walking speed, stance phase relative duration, stride length, cadence) 10 pelvic (pelvic tilt, obliquity, rotation at push-off maximum range of motion for all 3) and hip (3 hip angles at push-off, maximum hip flexion) kinematic parameters, 3 hip moments, and twenty-seven 3-dimensional peak muscle powers (labeled by joint, peak power, plane) developed in the lower limb joints during the gait cycle. RESULTS: Subjects in the clinical group were characterized by a 12.4% slower walking speed. The pelvis was more upwardly tilted (2.5 times) at push-off in the clinical group than in the nonclinical group. Obliquity, measured in the frontal plane, revealed that the pelvis dropped more (2.4 times) on the unsupported limb of the clinical group at push-off. In the sagittal plane, subjects in the clinical group absorbed less energy in their second hip peak power for decelerating the thigh extension and generated less hip pull (third hip peak power) than the nonclinical group by 34% and 29%, respectively. In the sagittal plane, the clinical group had 57% lower second knee peak power to straighten the joint shortly after heel strike, and 43% less knee absorption (third peak power) at push-off. During the push-off phase, the clinical group developed more than twice their third peak knee power in the frontal plane and 5 times more their third peak knee power in the transversal plane than the peak knee power of the nonclinical group in an attempt to control knee adduction and to facilitate body-weight transfer by an internal rotation. At the end of the swing phase, the fourth peak power in the sagittal plane showed the absorption power required to decelerate the leg; it was reduced by 35% in the clinical group, representing a strategy to increase walking speed by lengthening the stride length. CONCLUSIONS: Even at an early stage of hip OA, joint degeneration was compensated by an increase in pelvis motion and muscle power generation or absorption modifications in other lower limb joints.     

Intra-articular knee joint effusion induces quadriceps avoidance gait patterns

OBJECTIVES: (1) To identify adaptations caused by intra-articular knee joint effusion during walking and (2) to determine if knee joint effusion may be a causative factor in promoting quadriceps avoidance gait patterns. DESIGN: Gait testing of 14 healthy individuals who underwent incremental saline injections of the knee joint capsule.Background. Gait adaptations have been reported in the literature for knee injured and rehabilitating individuals. Knee joint capsular afferent activity can influence knee joint function. METHODS: Gait analysis was employed in a pre- and post-test, repeated measures design to determine lower extremity joint kinematics, kinetics, energetics and thigh EMG adaptations due to intra-articular knee joint effusion. RESULTS: Knee effusion caused an increase in hip and knee flexion through the stance phase. Knee extensor torque, impulse and negative and positive work were diminished with increased effusion levels. Quadriceps activity decreased and hamstring activity increased due to intra-articular knee joint effusion. DISCUSSION: These adaptations cannot be attributed to an injury, surgery or rehabilitation. Thus, the results of this experiment suggest knee joint capsular distention, via knee joint effusion, may be responsible for many gait adaptations reported for knee injured individuals in previous investigations. CONCLUSIONS: Knee joint effusion and the subsequent capsular distention can cause major alterations in the normal gait cycle and can be considered a causative factor promoting the acquisition of quadriceps avoidance gait patterns. RELEVANCE: This study provides reference data on the effects of intra-articular knee joint effusion on gait parameters by which future studies of injured or rehabilitating individuals can be compared.     

The effect of knee joint Mulligan taping on balance and gait in subacute stroke patients

[Purpose] This study aimed to determine the effects of Mulligan taping on balance and gait in subacute stroke patients. [Subjects] Thirty patients with subacute stroke were randomly divided into two groups: the experimental group (n = 15) and the control group (n = 15). Mulligan taping was applied to the knee joints of participants in the experimental group while placebo taping was applied to knee joints of subjects in the control group. Biodex was used to assess their balance ability and the GAITRite System was used to test gait. All measurements were performed before and after the intervention. [Results] Dynamic standing balance of the experimental group significantly improved after taping. Gait, gait cadence, velocity, step length, and stride length also improved significantly. However, no significant differences in standing balance or gait were observed for the control group. Furthermore, significant differences in dynamic standing balance, cadence, and velocity were found between the two groups after the intervention. [Conclusion] Our results demonstrate that Mulligan taping is effective for improving balance and gait in subacute stroke patients. Thus, this technique is a potential method for actively facilitating rehabilitation programs for hemiplegia patients.Key words: Stroke, Mulligan taping, Balance     

Foot contact pattern analysis in hemiplegic stroke patients: an implication for neurologic status determination

OBJECTIVE: To investigate the feasibility of using a foot contact pattern to predict neurologic recovery and the effect of ambulation training in hemiplegic stroke patients. DESIGN: Case-comparison study. SETTING: Gait laboratory in a tertiary care center. PARTICIPANTS: Sixty-five functionally ambulant hemiplegic stroke patients, and 30 healthy subjects serving as the control group. INTERVENTIONS: Gait analyses were performed by using the conventional gait analysis system (6 cameras) and the portable Computer DynoGraphy (CDG) system.Main outcome measures Walking velocity, step length, and cadence were measured from the conventional gait analysis system. Cyclogram, gaitline, and ground reaction force (GRF) patterns were recorded with the CDG system. RESULTS: Velocity, cadence, and step length increased in higher Brunnstrom stages (P<.01). Negative correlation was noted between the Brunnstrom stages and the foot contact patterns (P<.01). Lower cyclogram, GRF, and gaitline patterns were expected in subjects with higher Brunnstrom stages. There were high prediction probabilities between cyclogram, gaitline, and GRF patterns. CONCLUSIONS: Foot contact pattern can be a simple and reliable indicator of hemiplegic gait in stroke patients. It is closely related to patient's neurologic status and is correlated with parameters obtained from conventional gait analysis systems. Pathologic presentations are noted in both the affected and unaffected limbs, suggesting that rehabilitation programs should be implemented on both sides.     

A pilot study: influence of visual cue color on freezing of gait in persons with Parkinson's disease

Purpose.?To investigate the effect of red and green light beams on gait and freezing of gait (FOG) in persons with Parkinson's disease (PD).

Methods.?Seven persons with PD who experienced FOG participated in the study. Gait and turning performances were studied while walking with canes with red, green, and no light beams while ‘off’ and ‘on’ anti-Parkinsonian medications. Gait speed, cadence, and stride were recorded. Time and number of freezing episodes were recorded during a 50-foot walk and a 360° turn.

Results.?During ‘off’ medication, compared to no light, stride length improved when using the green light, but not the red. During the 50-foot walk, freezing episodes were reduced when using the green light compared to both the red and no light. During the 360° turn, time, number of steps and number of freezing episodes were reduced using the green light compared to the red and no light. During ‘on’ medication, gait speed and stride length improved more with the green light compared to the red. Neither color showed any effect on cadence during either medication state.

Conclusion.?A green light improved gait and alleviate FOG in persons with PD better than a red light or no light.     

Effects of different frequencies of rhythmic auditory cueing on the stride length,cadence, and gait speed in healthy young females

[Purpose] The aim of this study was to explore the effects of different frequencies of rhythmic auditory cueing (RAC) on stride length, cadence, and gait speed in healthy young females. The findings of this study might be used as clinical guidance of physical therapy for choosing the suitable frequency of RAC. [Subjects] Thirteen healthy young females were recruited in this study. [Methods] Ten meters walking tests were measured in all subjects under 4 conditions with each repeated 3 times and a 3-min seated rest period between repetitions. Subjects first walked as usual and then were asked to listen carefully to the rhythm of a metronome and walk with 3 kinds of RAC (90%, 100%, and 110% of the mean cadence). The three frequencies (90%, 100%, and 110%) of RAC were randomly assigned. Gait speed, stride length, and cadence were calculated, and a statistical analysis was performed using the SPSS (version 17.0) computer package. [Results] The gait speed and cadence of 90% RAC walking showed significant decreases compared with normal walking and 100% and 110% RAC walking. The stride length, cadence, and gait speed of 110% RAC walking showed significant increases compared with normal walking and 90% and 100% RAC walking. [Conclusion] Our results showed that 110% RAC was the best of the 3 cueing frequencies for improvement of stride length, cadence, and gait speed in healthy young females.Key words: Rhythmic auditory cueing, Frequency, Gait speed     

Changes in knee moments with contralateral versus ipsilateral cane usage in females with knee osteoarthritis

BACKGROUND: Conservative treatment for osteoarthritis often involves educating the patient in methods of decreasing the load transmitted through the diseased joint. The use of a cane is one such method and the correct placement of the cane with respect to an abnormal knee joint is crucial. The purpose of this study was to compare effects on knee moments of force of contralateral versus ipsilateral cane usage in female subjects with osteoarthritic knees. METHODS: A convenience sample of 14 subjects volunteered for this study. Subjects walked over force platforms while ground reaction force and three-dimensional kinematic data were captured using a Vicon 370 System. The subjects were tested walking: (a) unaided, (b) with ipsilateral cane, and (c) with contralateral cane. Inverse dynamics were employed to calculate temporal-spatial, kinematic and kinetic variables. Dependent variables included hip and knee frontal plane and sagittal plane moments of force, walking speed, cadence and stride length. Repeated measures ANOVA assessed differences among walking conditions. FINDINGS: Subjects walked significantly faster in the unaided gait condition owing to a higher cadence. Ipsilateral cane use resulted in significantly larger hip (versus contralateral P=0.018; versus unaided P=0.036) and knee (versus contralateral P=0.043; versus unaided P=0.030) frontal plane peak moments during gait. Contralateral cane placement was associated with the smallest peak knee abductor (P=<0.001) and flexor (P=<0.001) moments. Knee deformity (varus or valgus) did not have any significant effect on any variable possibly due to small sample size. INTERPRETATION: The results suggest that as is the case for the hip contralateral cane placement is the most efficacious for persons with knee osteoarthritis. In fact, no cane use may be preferable to ipsilateral cane usage as the latter resulted in the highest knee moments of force, a situation which may exacerbate pain and deformity.     

3D preliminary analysis gait in stroke patients: knee flexion in compensatory strategies]

OBJECTIVE: The aim of this preliminary study was to assess strategies of walking a stride in stroke patients with spastic right hemiplegia. MATERIAL AND METHODS: Gait was recorded in 3D in seven patients without other locomotion disorders. Kinematics data were studied only on the sagittal plane. The position and trajectory markers on the right side were studied during the swing phase in comparison with static standing position. Results were confronted with angular data. RESULTS: Three walking models were defined: 1) near normal gait with normal mobility in the knee; 2) gait with hicking while the flexion of the knee was reduced; 3) gait with a "talus" foot without motor recovery necessitating a pendular movement. DISCUSSION: The second pathological group was characterized with insufficient flexion in the knee in lifting the foot from the floor. In this group, patients adopted a compensation strategy with hicking in making the stride without touching the floor. We raised the question of limiting this adaptive strategy in order to enhance their remaining mobility. CONCLUSION: A 3D strategy gait analysis, before therapeutic choices, seems to confirm the value of analysing kinematic data in stroke patients with hemiplegia. The amplitude of knee mobility and hip compensation strategy can be specifically studied to improve the effectiveness of therapeutic strategies (orthesis, selective tibial neurotomy, botulinum toxin).     

膝周神经射频热凝治疗顽固性膝骨关节炎疼痛的临床效果

目的:探讨膝周神经射频热凝联合玻璃酸钠注射治疗顽固性膝骨关节炎疼痛的临床效果。方法:36例严重膝骨关节炎疼痛的患者,共57个患膝,随机分为两组:射频加玻璃酸钠组(R组),行膝周神经射频热凝加关节腔内玻璃酸钠注射;对照组(C组),单纯关节腔内玻璃酸钠注射。分别于治疗前、治疗后1周、治疗后6周和治疗后12周,记录患者疼痛视觉模拟评分(visual analoguescale,VAS)、患者对治疗效果综合评估(patient’s global assessment,PGA)和不良反应。结果:治疗后的12周内,R组VAS评分显著低于C组。R组PGA在第1周和第12周均显著高于C组。所有患者均未发生明显的不良反应。结论:膝周神经射频热凝联合玻璃酸钠注射治疗顽固性膝骨关节痛效果明显,安全可靠,可成为治疗老年性膝骨关节炎的有效手段。     

Gait analysis of elderly women after total knee arthroplasty

[Purpose] The purpose of this study was to investigate ability and muscle activities of elderly women after total knee arthroplasty (TKA) and compare them with those of healthy ones. [Subjects and Methods] Fifteen female patients with TKA due to advanced degenerative arthritis of the measured on knee joint and 19 healthy elderly females participated. Tibiofemoral angles of TKA patients were using a gait analysis system anterioposterior X-rays of the weight-bearing knee. The knee flexion angle and gait parameters were measured. Muscle activities and prolongation time were EMG system. The gait of the treated limb of each participant was evaluated in three consecutive trials at fast speed and comfortable speed. [Results] The knee flexion angle %stance phase, stride length, step length, speed, cadence, and gait cycle significantly decreased at both the fast speed and comfortable speeds, and the onset and duration time of rectus femoris activity was significantly increased at the comfortable speed in the TKA group. [Conclusion] In conclusion, elderly women who received TKA showed decreased gait ability and muscle activity compared to the healthy elderly women.Key words: Arthroplasty, Gait, Electromyography     

Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis

OBJECTIVE: To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking, according to radiographic severity of medial compartment knee osteoarthritis (OA). DESIGN: A prospective case control study of patients with medial compartment OA of the knee. SETTING: Gait analysis laboratory in a university hospital. PARTICIPANTS: Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles. Kellgren and Lawrence grading system was used for radiographic assessment of OA severity. RESULTS: The mean value of peak external adduction moment of the knee was higher in OA knees than the control. Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grades I and II knee OA patients. The first acceleration peak value after heel strike in these patients was relatively high compared with the control. Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grades I and II knee OA patients. CONCLUSIONS: The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grades I and II knee OA. The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA.     

Gait retraining after anterior cruciate ligament reconstruction

OBJECTIVES: To examine the effects of 2 gait retraining protocols on the gait patterns of patients with bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction. DESIGN: Randomized control, repeated-measures design. SETTING: Private orthopedic center and research facility. PARTICIPANTS: Sixteen patients with bone-patellar tendon-bone ACL reconstruction, randomly subdivided into 2 groups (group 1, n=8; group 2, n=8), and a healthy control group of 8 subjects. INTERVENTION: The 16 subjects with ACL reconstruction were randomly assigned to 2 different gait retraining protocols over a 6-week training interval: (1). a protocol using a predicted stride frequency calculated from the resonant frequency of a force-driven harmonic oscillator (FDHO) model or (2). a protocol using the preferred stride frequency (PSF). MAIN OUTCOME MEASURES: Gait analyses examining the lower-extremity kinematic, kinetic, and energetic gait patterns of each group. RESULTS: Gait retraining with the FDHO model showed improvements in lower-extremity positions, hip and knee extensor angular impulse, and work parameters. Gait retraining with the PSF demonstrated no statistical improvements. The FDHO training protocol facilitated a greater midstance knee range of motion (ROM) and greater rates of improvement for midstance ROM, hip extensor angular impulse, and concentric hip extensor work. CONCLUSIONS: Gait retraining with the resonant frequency of an FDHO model facilitated a greater recovery of gait function compared with training with the PSF.     

Functional outcome in knee osteoarthritis after treatment with hylan G-F 20: a prospective study

OBJECTIVE: To assess functional change in patients with knee osteoarthritis (OA) after treatment with intra-articular hyaluronic acid (Hylan G-F 20; Synvisc). DESIGN: Prospective case series with 6-month follow-up. SETTING: Outpatient community orthopedic practice. PARTICIPANTS: Eighty-four consecutive patients referred to private orthopedic group with symptoms and radiographic evidence of unilateral or bilateral knee OA who had either failed or could not tolerate the side effects of conservative treatment. Sixty-one patients completed the study. Nineteen patients were lost to follow-up. Four patients withdrew from study due to subsequent knee arthroplasty. INTERVENTION: Three weekly injections of Hylan G-F 20 into one or both (if bilaterally symptomatic) knees (110 knees total). OUTCOME MEASURE: SF-36 Health Survey was completed before treatment and 6 months after treatment. RESULTS: Statistically significant improvement (p < .001) in Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, and Role-Emotional categories on 6-month follow-up survey. Age and percent above ideal body weight were not significant predictors of functional change. CONCLUSION: Efficacy of intra-articular injection of Hylan G-F 20 for knee OA 6 months after injection is demonstrated in several categories of the SF-36, indicating a measurable improvement in overall functioning in these patients.     

Ankle-foot orthoses: effect on gait in children with cerebral palsy

PURPOSE: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. METHOD: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. RESULTS: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0.501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. CONCLUSIONS: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.     

The effects of isometric trunk exercises and dynamic trunk exercises on gait in elderly people

The purpose of this study was to compare the effects of dynamic trunk exercises and isometric trunk exercises on gait in elderly people. [Subjects] This study randomly allocated 20 elderly people to an isometric trunk exercise group (n=10) and a dynamic trunk exercise group (n=10). The exercises were performed for 30 minutes three times a week for 12 weeks. Gait speed, stride length, cadence, and step width were measured at a normal pace using GAITRite. All groups were evaluated before and after 12 weeks. [Results] The isometric exercise group showed a significant change in gait velocity, cadence, and left and right step lengths. The dynamic trunk exercise group showed a significant change in gait velocity, cadence, left and right step lengths, left and right step times, and left and right stride lengths. Moreover, a comparison of the exercise effect between the two groups showed a significant difference in gait velocity. [Conclusion] The results of this study suggest that isometric trunk exercises and dynamic trunk exercises have a positive effect on gait function in elderly people. In particular, isometric trunk exercises are recommended to promote gait velocity.Key words: Isometric trunk exercise, Dynamic trunk exercise, Gait     

Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks

BACKGROUND AND PURPOSE: Exacerbation of movement disorders while doing 2 tasks (dual task performance) is a characteristic feature of Parkinson disease (PD). The aim of this investigation was to identify whether the type of secondary task (motor or cognitive) determined the severity of dual task interference. SUBJECTS AND METHODS: Footstep patterns for 15 people with PD and 15 comparison subjects without PD were compared when they walked: (1) at a self-selected speed, (2) while simultaneously performing a motor task (coin transference), and (3) while simultaneously performing a cognitive task (digit subtraction). Gait speed, stride length, cadence, and the percentage of the gait cycle in double-limb stance (DS) were examined with a computerized stride analyzer. RESULTS: When there was no second task, the mean stride length was less in the group with PD (1.29 m) than in the comparison group (1.51 m), and the mean gait speed was less in the group with PD (71.47 m/min) than in the comparison group (87.29 m/min). The mean cadence was less in the group with PD (110.79 steps/min) than in the comparison group (115.81 steps/min). The percentage of the gait cycle in DS was greater in the group with PD (33.38%) than in the comparison group (31.21%). Both groups reduced their stride length and speed when they had to change from unitask performance to dual task performance and DS increased. For the group with PD, cadence also decreased. For both groups, the type of secondary task had a negligible effect on the performance decrement. DISCUSSION AND CONCLUSION: Although the performance of simultaneous motor or cognitive tasks compromised gait in people with PD, the type of secondary task was not a major determinant of the severity of dual task interference.