Adaptations to mass perturbations in transtibial amputees: kinetic or kinematic invariance?

Selles RW, Bussmann JB, Klip LM, Speet B, Van Soest AJ, Stam HJ. Adaptations to mass perturbations in transtibial amputees: kinetic or kinematic invariance? Arch Phys Med Rehabil 2004;85:2046-52.

Objective

To establish the adaptation strategy transtibial amputees use after mass perturbation of their prosthetic lower leg.

Design

We investigated whether the measured adaptations to mass perturbation of the lower leg in transtibial amputees can better be described as (1) a kinetic invariance strategy in which kinetics (joint torques) remain the same while kinematics (joint angles) change or (2) a kinematic invariance strategy in which kinematics remain the same while kinetics change.

Setting

A gait laboratory.

Participants

Ten transtibial amputees.

Interventions

Five different mass conditions.

Main outcome measures

Measured joint torques and angles during the swing phase in the different mass conditions.

Results

Mass perturbation induced more significant changes and larger effect sizes in joint torques than in joint angles.

Conclusions

Transtibial amputees adapt to mass perturbation primarily by maintaining the same kinematic pattern and adjusting their joint torques, that is, they use a kinematic invariance strategy. This implies that manipulating prosthetic inertial properties does not directly influence gait kinematics and that inertial properties should be evaluated in terms of the energetic cost of the swing phase.     

The influence of psychologic factors on diskography in patients with chronic axial low back pain

Derby R, Lee S-H, Chen Y, Kim B-J, Lee C-H, Hong Y-K, Lee J-E, Seo K-S. The influence of psychologic factors on diskography in patients with chronic axial low back pain.

Objective

To determine whether a patient's presenting psychometric scores affect the findings of a pressure and injection speed-controlled manometric lumbar diskography in patients with chronic low back pain (CLBP).

Design

A prospective, correlation-based, investigative study.

Setting

Free-standing ambulatory spine surgery center.

Participants

Two hundred sixty-three disks from 81 patients (54 men, 27 women).

Intervention

Diskography was performed using pressure and injection speed-controlled techniques. The patients were divided into psychometric subgroups (normal, at risk, abnormal) according to the Distress and Risk Assessment Method (DRAM).

Main Outcome Measures

The diskography findings on each psychometric DRAM subgroup were evaluated.

Results

Across the individual psychometric categories, the positive rates of diskography in the normal, at-risk, and abnormal subgroups were 75.0% (9/12), 59.5% (25/42), and 70.4% (19/27), respectively (P>.05). The mean numeric rating scores of pain at 15 and 50psi above the opening pressure were similar in the 3 psychometric subgroups. There was no correlation between the diskography results and the psychometric subgroupings.

Conclusions

In patients with CLBP, there is no correlation between the presenting psychometric DRAM score and the findings from pressure and injection speed-controlled manometric lumbar diskography.     

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.     

Employee empowerment, innovative behavior and job productivity of public health nurses: a cross-sectional questionnaire survey

Background

Employee empowerment is an important organizational issue. Empowered employees with new ideas and innovative attributes may increase their ability to respond more effectively to face extensive changes in current public health care work environments.

Objectives

The objective of this study was to investigate the relationships between employee empowerment, innovative behaviors and job productivity of public health nurses (PHNs).

Design

This study conducted a cross-sectional research design.

Settings and participants

Purposive sampling was conducted from six health bureaus in northern Taiwan. 670 PHNs were approached and 576 valid questionnaires were collected, with a response rate of 85.9%.

Methods

Structured questionnaires were used to collect data by post.

Results

Meaning and competence subscales of psychological empowerment, information and opportunity subscales of organizational empowerment, and innovative behaviors were the predictors of job productivity, only accounting for 16.4% of the variance. The competence subscale of psychological empowerment made the most contribution to job productivity (β = 0.31). Meaning subscale of psychological empowerment has a negative impact on job productivity.

Conclusions

Employee empowerment and innovative behavior of PHNs have little influence on job productivity. Employees with greater competence for delivering public health showed higher self-evaluated job productivity. The negative influences on job productivity possibly caused by conflict meaning on public health among PHNs in current public health policy. It should be an issue in further researches. Public health department should strengthen continuing educations to foster competence of psychological sense of empowerment and innovative behavior to increase job productivity.     

The Associations Between the Dominant and Nondominant Peak External Knee Adductor Moments During Gait in Healthy Subjects: Evidence for Symmetry

Teichtahl AJ, Wluka AE, Morris ME, Davis SR, Cicuttini FM. The associations between the dominant and nondominant peak external knee adductor moments during gait in healthy subjects: evidence for symmetry.

Objectives

There is growing interest in the role of the knee adduction moment in the pathogenesis of knee pain and osteoarthritis. It is unclear whether the knee adduction moment is similar between the dominant and nondominant legs during locomotion. This study examined whether asymmetry exists in the peak knee adductor moments during gait in healthy adults.

Design

Cross-sectional study.

Setting

Musculoskeletal Research Centre, La Trobe University, Melbourne, Victoria, Australia.

Participants

Three-dimensional Vicon gait analyses were performed for 17 healthy men and women.

Interventions

Not applicable.

Main Outcome Measures

The external dominant and nondominant peak knee adduction moments during early and late stance were analyzed to determine whether any significant differences occurred between limbs.

Results

Peak knee adductor moments for dominant and nondominant limbs were significantly correlated during early (R=0.61, P=0.009) and late (R=0.72, P=0.001) stance. After adjustment for age and sex, there was an associated 0.58 (P=0.030) and 0.98 (P=0.009) unit increase in the peak knee adduction moment in the nondominant leg, for every 1 unit increase in the dominant leg during the early and late stance phases of gait, respectively. Further evidence for symmetry was provided by the symmetry index, which was 0.04% and 0.62% for early and late stance, respectively.

Conclusions

In healthy subjects, the magnitude of the dominant limb peak external knee adduction moments during stance, and in particular late stance, appears representative of the magnitude of the moment in the nondominant limb. These findings imply symmetry between these moments and may have important implications when collecting data for limb analyses among healthy subjects. Whether gait symmetry protects against the onset of unilateral (or increases the risk for bilateral) pathological joint changes will need to be confirmed longitudinally.     

The effects of hip and ankle stretching on gait function of older people

Christiansen CL. The effects of hip and ankle stretching on gait function of older people.

Objective

To examine effects of hip and ankle stretching on gait function of older people.

Design

Randomized controlled trial.

Setting

Flexibility training was performed in participants' homes. Assessments were performed in a biomechanics laboratory.

Participants

Forty healthy volunteers (mean age ± SD, 72.1±4.7y) randomized to 2 groups: intervention (n=20) and control (n=20).

Intervention

Intervention participants performed an 8-week stretching program, and control group participants maintained activity level for 8 weeks. One investigator made weekly visits to instruct and monitor participants.

Main Outcome Measures

Primary outcome measures were passive joint motion for hip extension and ankle dorsiflexion and freely chosen gait speed. Secondary outcome measures were gait parameters during freely chosen gait speed and set gait speed walking (stride length, joint displacement).

Results

Compared with the control group, the intervention group had increased combined hip and knee motion (P=.023), ankle motion (P=.020), and freely chosen gait speed (P=.016). The intervention group showed statistically nonsignificant trends of increased stride length at freely chosen gait speed and set gait speed.

Conclusions

Findings suggest joint motion is a modifiable impairment that is effectively targeted with flexibility training for older people. Participants in the intervention group had improvements in joint motion as well as increased freely chosen gait speed. Mechanisms responsible for changes in freely chosen gait speed warrant further investigation.     

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

Objective

To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.

Design

Pre-post interventional study.

Setting

General community.

Participants

Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.

Intervention

After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.

Main Outcome Measures

Falls risk (Falls Risk of Older People—Community Setting) and balance measures.

Results

Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).

Conclusions

An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.     

HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in adolescents: A cross-sectional questionnaire survey

Background

High incidence rates of HIV/AIDS infections among youth draw attention to the need for emphasizing the reduction of risky sexual behavior, a major contributor to the spread of HIV/AIDS. Few researchers have examined the relationship between self-efficacy for HIV/AIDS preventions, depressive symptoms, and adolescent risky sexual behavior. This insufficient understanding limits nurses’ ability to provide effective programs for reducing adolescents’ risky sexual behaviors.

Objectives

This study was conducted to investigate the relationships among HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in Taiwanese adolescents.

Design

A cross-sectional, correlational study.

Settings

Seven vocational high schools located in a metropolitan area in southern Taiwan.

Participants

A convenience sample of 16-18-year-old vocational high school Taiwanese adolescents (n = 734) participated in this study.

Methods

Several self-administrated questionnaires, including HIV/AIDS Preventive Self-efficacy scale, the Center for Epidemiological Studies-Depression scale, Safe Sex Behavior Questionnaire, and a form for demographic data, were used to collect data.

Results

Taiwanese adolescents who had higher HIV/AIDS preventive self-efficacy scores had less overall risky sexual behavior. Adolescents who had less depressive symptoms had higher HIV/AIDS preventive self-efficacy. More depressive symptoms were correlated to more risky sexual behavior.

Conclusion

Improving Taiwanese adolescents’ HIV/AIDS preventive self-efficacy could be useful to reduce risky sexual behaviors in this population. Results of this study may assist nurses in understanding factors related to adolescents HIV/AIDS related risky sexual behavior and its’ preventions. However, future longitudinal studies are needed to clarify whether depressive symptoms is a major influential factor that might interfere with the effectiveness of HIV/AIDS prevention programs.     

A study to compare the effects of massage and static touch on experimentally induced pain in healthy volunteers

Objective

To investigate the hypoalgesic effects of massage on experimental pain.

Design

A cross-over intervention study separated by a 24-hour washout period. During each experiment, participants completed five cold-induced pain tests, two before the intervention and three during the intervention. During each test, participants immersed their hand in iced water and reported the first sensation of pain and pain intensity after a further 30 seconds.

Setting

Laboratory setting.

Participants

A volunteer sample of 30 university staff and students without known pathology, recruited from noticeboard advertisements.

Interventions

Participants received massage in one experiment and static touch in the other experiment. Interventions were administered to the ipsilateral arm for 4 minutes immediately before the hand was immersed in iced water.

Main outcome measures

Time to pain threshold and the odds of a reduction in pain intensity and an increase in pain relief.

Results

A mixed model analysis was used to establish how measures varied, according to baseline, during static touch and during massage. Massage increased the pain threshold by a factor of 1.08 (95% confidence interval 0.99-1.17) compared with static touch, but this failed to reach statistical significance (P = 0.088). Massage was more likely to result in a report of low pain intensity than static touch (odds ratio 0.26, 95% confidence interval 0.10-0.71, P = 0.007). Massage was more likely to result in a state of high pain relief than static touch (odds ratio 7.7, 95% confidence interval 3.0-19.8, P < 0.001).

Conclusion

Massage produced hypoalgesic effects on experimental pain in healthy volunteers.     

Kinematics in the Terminal Swing Phase of Unilateral Transfemoral Amputees: Microprocessor-Controlled Versus Swing-Phase Control Prosthetic Knees

Mâaref K, Martinet N, Grumillier C, Ghannouchi S, André JM, Paysant J. Kinematics in the terminal swing phase of unilateral transfemoral amputees: microprocessor-controlled versus swing-phase control prosthetic knees.

Objectives

To analyze the spatiotemporal parameters in the terminal swing phase of the prosthetic limb in unilateral transfemoral amputees (TFAs) compared with a group of asymptomatic subjects, and to identify a latency period (LP) in the TFA between the full extension of the prosthetic knee and the initial ground contact of the ipsilateral foot. To study the correlation between the LP and the duration of the swing phase. To evaluate the influence of the type of knee, the time since amputation, and the amputation level on the latency period.

Design

Three-dimensional gait analysis with an optoelectronic device.

Setting

Gait analysis laboratory of a re-education and functional rehabilitation service.

Participants

TFA (n=29) and able-bodied (n=15) subjects.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal and kinematics gait parameters.

Results

The swing phase and the LP of the prosthetic limb, associated with a consequently longer single-limb stance phase in the intact limb, were significantly longer than those measured in the intact limbs of these subjects, as well as those measured on both lower limbs of the able-bodied subjects (P<.05). There is a positive correlation (P<.05; r²=.58 between the LP and the swing phase on the TFA's prosthetic side. The LP measured in the prosthetic limb of TFA with a swing-phase control prosthetic knee is significantly greater than in those using the microprocessor-controlled prosthetic knee (P<.05).

Conclusions

Of negligible duration in able-bodied subjects and in the intact limb of TFA, the LP is significantly greater in the prosthetic limb. It can explain the lengthened swing phase on the prosthetic side of those subjects. The use of a microprocessor-controlled prosthetic knee allows the LP to be reduced. This LP appears to be necessary to insure the stability of the prosthetic knee. We suggest calling this time “confidence time.”     

Within-day repeatability of the endurance shuttle walk test

Objective

To determine the need for a practice walk for the endurance shuttle walk test (ESWT) following the performance of two incremental shuttle walk tests (ISWTs) - one practice and one test - on the same day.

Design

Retrospective data analysis of shuttle walk test measurements. All participants had performed two ISWTs and two ESWTs at a single visit, prior to commencing pulmonary rehabilitation.

Setting

Outpatient physiotherapy department of a university hospital.

Participants

Forty-four patients (33 males, 11 females) with a primary diagnosis of chronic obstructive pulmonary disease, referred for routine pulmonary rehabilitation.

Measurements

Shuttle walk test distance and time, Borg breathlessness score, heart rate and pulsed oxygen saturation.

Results

The mean age of the group was 67.6 years [standard deviation (SD) 9.0] and mean forced expiratory volume in 1 second was 37% predicted (SD 13). The mean times walked during ESWTs 1 and 2 were 195 and 207 seconds (SD 115 and 138), respectively. Using the analysis recommended by Bland and Altman, the mean of the individual differences (d) between Tests 1 and 2 was 12 seconds, with limits of agreement from −88 to +112 seconds.

Conclusion

A practice endurance shuttle walk is unnecessary following performance of ISWTs on the same day.     

Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome

Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil 2003;84:1637-41.

Objectives

To detect the clinical and radiologic characteristics of posttraumatic hydrocephalus (PTH), to define its prognostic value, and to assess the effects of shunt surgery.

Design

Correlational study on a prospective cohort.

Setting

Brain injury rehabilitation center.

Participants

One hundred forty patients with severe traumatic brain injury (TBI) referred to an inpatient intensive rehabilitation unit of primary care in a university-based system.

Interventions

Not applicable.

Main outcome measures

The Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), FIM™ instrument, and Neurobehavioural Rating Scale (NRS), as well as single-photon emission computed tomography (SPECT) and magnetic resonance imaging.

Results

PTH was found in 45% of patients. Risk factors for PTH were as follows: age (P<.04), duration of coma (P<.0001), and decompressive craniectomy (P<.0001). PTH correlated with the degree of hypoperfusion in the temporal lobes (P<.001). Patients who showed clinical deterioration improved after surgery. PTH correlated significantly with GOS, DRS, FIM, and NRS (P<.0001) 1 year after the trauma, and it influenced the appearance of posttraumatic epilepsy (P<.02).

Conclusions

PTH concerns about 50% of patients with severe TBI. It influences functional and behavioral outcome and the appearance of posttraumatic epilepsy. The selection of patients for surgery can be defined principally on a clinical basis. SPECT may be helpful for differentiating ventricular enlargement due to cortical atrophy and hydrocephalus.     

Interlimb Muscle and Fat Comparisons in Persons With Lower-Limb Amputation

Sherk VD, Bemben MG, Bemben DA. Interlimb muscle and fat comparisons in persons with lower-limb amputation.

Objectives

To investigate differences in muscle and fat tissue between amputated and intact limbs in subjects with transfemoral and transtibial amputations and to determine the effect of amputation level on limb differences. We hypothesized that the amputated limb would have a higher relative amount of fat than the intact limb, and transfemoral amputees would have greater limb differences in muscle size than transtibial amputees.

Design

Cross-sectional, repeated-measures design.

Setting

Laboratory.

Participants

Subjects included persons with unilateral transfemoral (TF) (n=5) and transtibial (TT) (n=7) amputations and age- and sex-matched nonamputation controls (n=12).

Interventions

Not applicable.

Main Outcome Measures

Muscle cross-sectional areas and fat cross-sectional areas of the end of residual limbs were compared with similar cross-sectional sites of the intact limb by using peripheral quantitative computed tomography scans. Thigh and lower-leg fat mass (FM) and bone-free lean body mass were measured by dual-energy x-ray absorptiometry.

Results

There was a 93% to 117% difference between limbs in muscle cross-sectional areas for TF and TT. TT had a between-limb difference of 39% for fat cross-sectional areas. Thigh bone-free lean body masses and FM were significantly (P<.05) lower for the amputated limb for both TF and TT. Thigh percent fat was significantly (P<.05) higher in the amputated thigh for TF and TT, but limb differences were greater in TF.

Conclusions

Muscle atrophy was prevalent in the residual limb with larger relative amounts of fat in the thighs, especially in TF subjects.     

Reliability and Validity of the Functional Gait Assessment (German Version) in Subacute Stroke Patients

Thieme H, Ritschel C, Zange C. Reliability and validity of the Functional Gait Assessment (German version) in subacute stroke patients.

Objective

To investigate validity and reliability of the Functional Gait Assessment (FGA) (German version) as a measure for balance abilities during walking in subacute stroke patients.

Design

Cohort study.

Setting

Inpatient rehabilitation center.

Participants

Ambulatory subjects (N=28) at a maximum of 6 months after stroke participated in this study. One direct observer and 2 video observers rated the FGA.

Interventions

Not applicable.

Main Outcome Measures

Performance of the FGA was video recorded and directly rated. For testing concurrent validity of the FGA, subjects also completed testing in the Berg Balance Scale, fast walking speed, the Functional Ambulatory Category, the Rivermead Mobility Index, and the Barthel Index. Intrarater reliability, interrater reliability, and concurrent validity of the FGA were analyzed.

Results

Intrarater (intraclass correlation coefficient=.97) and interrater reliability (intraclass correlation coefficient=.94) were almost perfect for total scores. Reliability of single items varied between substantial and almost perfect values. Analysis revealed significant correlations between the FGA and other measures of gait and balance functions between Spearman rho values of .71 and .93. The FGA differs significantly between levels of gait ability (Functional Ambulatory Category) (P≤.01).

Conclusions

Almost perfect intrarater and interrater reliability for total FGA scores and good concurrent validity were shown in this study. Therefore, the FGA (German version) can be used as a reliable and valid tool to assess functional gait performance of patients in subacute stages after stroke.     

Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation

Bussmann JB, Schrauwen HJ, Stam HJ. Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation.

Objectives

To test the hypothesis that people with a unilateral traumatic transtibial amputation are less active than people without an amputation, and to explore whether both groups have a similar heart rate response while walking.

Design

A case-comparison study.

Setting

General community.

Participants

Nine subjects with a unilateral traumatic transtibial amputation and 9 matched subjects without known impairments.

Interventions

Not applicable.

Main Outcome Measures

Percentage of dynamic activities in 48 hours (expressing activity level). Additionally, we examined heart rate and percentage heart rate reserve during walking (expressing heart rate response) and body motility during walking (expressing walking speed). These parameters were objectively measured at participants’ homes on 2 consecutive days.

Results

Subjects with an amputation showed a lower percentage of dynamic activities (6.0% vs 11.7% in a 48-h period, P=.02). No significant differences were found between the 2 groups in heart rate (91.1bpm vs 89.5bpm, P=.86) and percentage heart rate reserve during walking (28.2% vs 27.5%, P=1.0). Body motility during walking was lower in the amputation group (.14g vs .18g, P<.01).

Conclusions

Our results support our hypothesis that persons with a unilateral traumatic transtibial amputation are considerably less active than persons without known impairments. The results indicate that heart rate response during walking is similar in both groups, and is probably regulated by adapting one’s walking speed.     

The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury

van Londen A, Herwegh M, van der Zee CH, Daffertshofer A, Smit CA, Niezen A, Janssen TW. The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury.

Objective

To study effects of surface electric stimulation of the gluteal muscles on the interface pressure in seated persons with spinal cord injury (SCI).

Design

One session in which alternating and simultaneous surface electric stimulation protocols were applied in random order.

Setting

Research laboratory of a rehabilitation center.

Participants

Thirteen subjects with SCI.

Intervention

Surface electric stimulation of the gluteal muscles.

Main Outcome Measures

Interface pressure, maximum pressure, pressure spread, and pressure gradient for the stimulation measurement. Variables were compared using 2-tailed paired t tests.

Results

Alternating and simultaneous stimulation protocol caused a significant (P<.01) decrease in interface pressure (-17±12mmHg, -19±14mmHg) and pressure gradient (-12±11mmHg, -14±12mmHg) during stimulation periods compared with rest periods. There was no significant difference in effects between the 2 protocols.

Conclusions

Surface electric stimulation of the gluteal muscles in persons with SCI causes a decrease in interface pressure. This might restore blood flow in compressed tissue and help prevent pressure ulcers.     

Gait Analysis for Evaluating the Relationship Between Increased Signal Intensity on T2-Weighted Magnetic Resonance Imaging and Gait Function in Cervical Spondylotic Myelopathy

Kim CR, Yoo JY, Lee SH, Lee DH, Rhim SC. Gait analysis for evaluating the relationship between increased signal intensity on T2-weighted magnetic resonance imaging and gait function in cervical spondylotic myelopathy.

Objective

To determine relationships between increased signal intensity (ISI) on T2-weighted cervical spine magnetic resonance imaging (MRI) and parameters of gait analysis in patients with cervical spondylotic myelopathy (CSM).

Design

Retrospective comparative study.

Setting

Gait analysis laboratory.

Participants

Patients (N=36) who undertook cervical laminectomy or laminoplasty because of CSM.

Interventions

Not applicable.

Main Outcome Measures

Subjects were evaluated by using the modified Japanese Orthopaedic Association (JOA) scale, the Nurick scale, cervical spine MRI, and gait analysis. Two radiologists classified patients into 3 groups: intense, faint, and no ISI.

Results

Relative to patients without ISI, those with ISI showed significantly slower gait speed, longer step time, decreased single-limb support time, increased double-limb support time, and limited range of motion of knee and ankle (P<.05). Increased intensity tended to correlate with poor gait function including slower gait speed, longer step time, decreased single-limb support time, and increased double-limb support time. The modified JOA and Nurick scale did not correlate with ISI.

Conclusions

In patients with CSM who received surgical treatment, more intense ISI on T2-weighted MRI correlated preoperatively with increased difficulties in gait function. Gait analysis may be a useful tool for evaluating gait functions in cervical myelopathy.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

Assistive Walking Devices in Nonambulant Patients Undergoing Rehabilitation After Stroke: The Effects on Functional Mobility, Walking Impairments, and Patients' Opinion

Tyson SF, Rogerson L. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.

Objective

To assess the immediate effects of assistive walking devices on functional mobility, walking impairments, and patients' opinions in nonambulant patients after stroke.

Design

Randomized crossover trial.

Setting

Inpatient rehabilitation units of 3 United Kingdom hospitals.

Participants

Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking.

Interventions

Five walking conditions: (1) Walking with no device (the control condition), (2) walking with a walking cane, (3) ankle foot orthosis, (4) slider shoe, and (5) a combination of all 3 devices.

Main Outcome Measures

Functional mobility (functional ambulation categories), walking impairments (speed, step length of the weak leg), and patients' opinions.

Results

Functional mobility improved with all assistive devices (P<.0001-.005; effect sizes 1.68-0.52; number needed to treat=2-5). Walking impairments were unchanged (P<.800-.988). Participants were generally positive about the devices. They felt their walking, confidence, and safety improved and found the appearance and comfort of the devices acceptable. They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them.

Conclusions

Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke. No changes in walking impairments were found. Participants were generally positive about using the devices. The results support the use of assistive walking devices to enable early mobilization after stroke; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility.     

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.

Objective

To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.

Design

Comparative gait analysis.

Setting

University-based aquatic therapy center.

Participants

Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal and kinematic gait parameters.

Results

The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.

Conclusions

The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking.