A novel mechanotronic orthosis enables symmetrical gait kinematics in a patient with a femoral nerve palsy – a case study

The usage of stance- and swing-phase control orthoses (SSCOs) is a good option in patients with neuromuscular insufficiency of the quadriceps muscle in a broad range of musculo-skeletal disorders. The subjective sensation of improved mobility in daily life and walking comfort could be objectively confirmed by the ability to walk without crutches and by harmonization of the gait patterns in hip and knee. They could also be a considered mobility device after limb salvage surgery, which may even have an impact on preoperative decision making.

• IMPLICATIONS FOR REHABILITATION

• Symmetric gate in spite of femoral nerve palsy.

• Early gate improvements even after hours.

• High patient?s motivation to use the device.

     

Do French medical schools provide appropriate training on gait and gait disorders?

AimEvaluate the need for integrated teaching on normal and pathological gait at medical school.MethodA questionnaire filled out by 91 French general practitioners (GPs, 130 of whom were contacted) with an average of 19 years of practice and 56 sixth-year medical students. Assessment of the students’ knowledge of normal and pathological gait.ResultsSeventy-two percent of the GPs and 82% of the students considered gait to be a frequent reason for consultation. Eighty-nine percent of the GPs and 98% of the students stated that they had difficulty analysing a gait disorder. Eighty percent of the GPs and 50% of the students considered that the teaching on gait and gait disorders at medical school was insufficient. The responses notably highlighted the poor coordination between teachers from the various disciplines involved. The students’ knowledge of gait was poor (only 20% of their answers were correct). This was especially true for semiological questions, which were correctly answered by less than one student in 10.ConclusionThe results of the present study demonstrate that French medical schools need to provide better teaching on gait. We, therefore, propose the implementation of an integrated teaching programme with a sufficient focus on functional and semiological approaches.     

Sustained prefrontal activation during ataxic gait: a compensatory mechanism for ataxic stroke?

There is accumulated evidence that cortical reorganization plays an important role in motor recovery after supratentorial stroke. However neural mechanisms underlying functional recovery of ataxia after infratentorial stroke remain unclear. We investigated cortical activations during ataxic gait in patients with infratentorial stroke to test the hypothesis that cerebral cortices were involved in compensatory mechanisms for ataxic gait. Twelve patients with infratentorial stroke (mean duration+/-S.D. from the onset: 88.3+/-44.8 days) and 11 age-matched healthy subjects participated in this study. All patients had predominant ataxia without severe hemiparesis. We measured cortical activation as assessed by task-related increase of oxygenated hemoglobin during gait on a treadmill using functional near-infrared spectroscopy. Task consisted of three repetitions of gait period alternated with rest period. In controls, cortical activations in the lateral and medial prefrontal cortex during the acceleration phase tended to be attenuated during the steady phase of the gait period while these activations were sustained throughout the gait period in ataxic patients. Repeated measures ANOVA for cortical activation revealed significant interactions (p<0.005) between phase (acceleration/steady) and group (control/stroke) in the medial and lateral prefrontal regions. These results suggest that sustained prefrontal activation during ataxic gait might be relevant to compensatory mechanisms for ataxic gait after infratentorial stroke.     

Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Huisinga JM, Filipi ML, Schmid KK, Stergiou N. Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Objective

To evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis (MS) to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics.

Design

Cross-sectional.

Setting

Biomechanics laboratory.

Participants

Subjects with MS (n=32) and age- and sex-matched controls (n=30).

Interventions

None.

Main Outcome Measures

Fatigue Severity Scale (FSS), Modified Fatigue Index Scale (MFIS), and 36-Item Short Form Health Survey (SF-36) to assess fatigue and general health. Biomechanical gait analysis was performed to measure peak joint torques and powers in the sagittal plane at the ankle, knee, and hip. Correlations were performed between fatigue measures and degree of deficit within each patient with MS for each joint torque and power measure.

Results

FSS score significantly correlated with deficits in ankle power generation at late stance and walking velocity. MFIS score significantly correlated with deficits in peak knee extensor torque and knee power absorption at early stance. SF-36 subscale scores correlated with several joint torque and power variables.

Conclusions

Subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS.     

The effect of prosthetic mass properties on the gait of transtibial amputees—a mathematical model

Purpose:?Present models in the literature, predicting that prostheses should not be too lightweight, are not supported by empirical evidence. Recent studies suggest that these models are incorrectly based on the assumption that the swing phase is uninfluenced by muscle activity. The purpose of the present study was to introduce a new mathematical model to predict the effect of mass properties on the gait of transtibial amputees, based on experimental findings that subjects adapt to mass perturbations by maintaining the same joint kinematics.

Method:?Effect of mass perturbations on the lower leg was evaluated in terms of muscular cost and forces between stump and socket, using a linked-segment model of the swing phase. Gait analysis and anthropometric data from 10 transtibial amputees were used as model input.

Results:?Location of perturbation strongly influenced the muscular cost. Cost generally increased after distally adding mass but decreased after proximally adding mass to the lower leg. Stump?–?socket interface forces always increased after mass addition.

Conclusions:?A new model was introduced, predicting that the weight of distally located components (e.g. foot, ankle, shoe) strongly influence the estimated muscular cost, in contrast to proximal components. A comparison with experimental literature suggests this new model better describes the experimental data than existing models.     

The impact of rollator loading on gait and fall risk in neurorehabilitation – a pilot study

Purpose: Rollator loading is an application used clinically sometimes to improve functional integrity and security of the patients’ gait. As empirical evidence supporting this intervention is equivocal, the purpose of this study was to examine the effects of rollator loading on several gait parameters and fall risk. Methods: An explicatory experiment with a follow-up cohort study of falls was conducted. In the experimental part of the study, participants (n?=?25) were evaluated three times by means of different gait and fall risk assessments, whereby each trial was carried out with different rollator loading (0, 4.5 and 9?kg, respectively). Participants were blinded towards the applied load. In addition, the odds ratio of falls with respect to rollator loading in all-day rehabilitation life was determined. Results: No changes in spatio-temporal gait parameters and fall risk in relation to a particular load could be identified by clinical measures in the tested sample. A separate sub-group analysis (Parkinson’s disease, hemiparesis and ataxia) showed only little impact of the load in each case. Rollator loading had no impact on the odds ratio of inpatient fall risk. Conclusion: On the basis of our findings, weighting of rollators can neither be discouraged nor recommended.

• Implications for Rehabilitation

• Unless more research is has been conducted on this topic, rollator loading can neither be recommended nor discouraged in individuals suffering from neurologic diseases.

• There is more research needed to examine the impact on ambulation in distinct conditions such as severe ataxia and fear of falling.

     

Does clinic-measured gait speed differ from gait speed measured in the community in people with stroke?

OBJECTIVE: To compare the extent to which gait speed measured in the clinic setting differs from that measured in the community. DESIGN: Participants completed the 10-m walk test at a self-selected speed in a clinic SETTING. Following this they completed a 300-m community-based walking circuit that covered a variety of environmental conditions. Gait velocity was sampled at different points in the circuit. The same circuit and sampling points were used for all participants. Clinic gait velocity was compared to gait velocity measured on five occasions during the community-based circuit. SETTING: Physiotherapy clinic and local shopping mall. PARTICIPANTS: Twenty-eight chronic stroke patients who regularly accessed the community divided into two groups based on their gait velocity in the clinic. MAIN OUTCOME MEASURES: Walking velocity. RESULTS: Spearman rank correlation coefficient indicated that there was a strong correlation between the total time taken to walk the 300-m course and the clinic-based gait velocity (r = -0.88, P < 0.0001). A linear mixed model with repeated measures analysis revealed significant interaction between community measures for group A versus group B (F4,26 = 4.49, P = 0.0068) and significant differences across community conditions (F4,26 = 7.12, P = 0.0005). CONCLUSION: The clinic-based 10-m walk test is able to predict walking velocity in a community setting in chronic stroke patients who score 0.8 m/s or faster. However, for those who score less than 0.8 m/s in the clinic test, gait velocity in the community may be overestimated.     

Can toe-walking contribute to stiff-legged gait?

OBJECTIVE: Spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, has previously been attributed solely to spastic quadriceps activity. In earlier work, the authors suggested that reduced knee flexion in swing can be attributed to other indirect factors, such as poor hip flexion and abnormal foot-ankle function during gait. The present study was undertaken to determine whether toe-walking, which often occurs in conjunction with stiff-legged gait, in and of itself, might explain some of the reduced knee flexion in swing. DESIGN: An analysis was performed of three-dimensional kinematic data collected from able-bodied subjects while walking on their toes vs. normal heel-toe walking. RESULTS: Peak knee flexion was reduced significantly compared with normal heel-toe walking (42.2+/-8.9 degrees toe-walking vs. 59.2+/-5.7 degrees heel-toe walking; P < 0.00001). CONCLUSIONS: This finding, which occurred when controlling for walking speed, may be clinically relevant for patients who have both a toe-walking and a stiff-legged gait pattern. Some of the reduced knee flexion in swing may be merely a consequence of toe-walking, rather than a result of other causes, such as intrinsic spasticity or abnormal muscle firing about the knee.     

Age-related cognitive task effects on gait characteristics: do different working memory components make a difference?

Background

To explore if stimulus–response (S-R) characteristics of the silent period (SP) after transcranial magnetic stimulation (TMS) are affected by changing the SP definition and by changing data presentation in healthy individuals. This information would be clinically relevant to predict motor recovery in patients with stroke using stimulus–response curves.

Methods

Different landmarks to define the SP onset and offset were used to construct S-R curves from the biceps brachii (BB) and abductor digiti minimi (ADM) muscles in 15 healthy participants using rectified versus non-rectified surface electromyography (EMG). A non-linear mixed model fit to a sigmoid Boltzmann function described the S-R characteristics. Differences between S-R characteristics were compared using paired sample t-tests. The Bonferroni correction was used to adjust for multiple testing.

Results

For the BB, no differences in S-R characteristics were observed between different SP onset and offset markers, while there was no influence of data presentation either. For the ADM, no differences were observed between different SP onset markers, whereas both the SP offset marker “the first return of any EMG-activity” and presenting non-rectified data showed lower active motor thresholds and less steep slopes.

Conclusions

The use of different landmarks to define the SP offset as well as data presentation affect SP S-R characteristics of the ADM in healthy individuals.     

Cerebellar stimulation and gait recovery北大核心CSCD

BACKGROUND AND OBJECTIVE After a stroke,the contralesional cerebellum is implicated in functional reorganization of the motor network.In animal models,stitnulation of the cerebellar-cortical networks has been found to improve recovery.This study assessed the effect of cerebellar intermittent Omega-burst stimulation(CRB-iTBS),a variation of repetitive transcranial magnetic stimulation(rTMS),on gait recovery after a stroke.     

Preliminary effectiveness of a sequential exercise intervention on gait function in ambulant patients with multiple sclerosis — A pilot study

BackgroundPatients with multiple sclerosis (pwMS) often experience a decline in motor function and performance during prolonged walking, which potentially is associated with reduced ankle push-off power and might be alleviated through structured exercise. The objectives of this pilot study were to assess ankle push-off power and walking performance in pwMS and healthy controls, and the preliminary effectiveness of a sequential exercise program (resistance training followed by walking-specific endurance training) on ankle push-off power and walking performance.MethodsPwMS (N = 10) with self-reported reduced walking performance and healthy controls (N = 10; at baseline only) underwent 3D gait analysis during a self-paced 12-minute walking test to assess walking performance prior to and following a sequential exercise program. Secondary testing paradigms comprised isometric muscle testing (triceps surae), cardiopulmonary exercise testing and self-report measures.FindingsPwMS had a shorter 12-minute walking distance, and lower peak ankle push-off power (most-affected leg) in comparison to healthy controls. There was no minute-to-minute decline in walking performance. The 8-week resistance training significantly improved walking distance. In parallel, higher peak and speed-normalized ankle push-off power were found in the less-affected side. No additional changes were found following the walking-specific endurance training phase.InterpretationThere was no walking-related motor fatigue found during a self-paced 12-minute walking test despite reduced ankle push-off power, and self-reported walking problems. Preliminary effects suggest a positive effect of resistance training on walking performance, potentially associated with increases in ankle push-off power, interestingly, in the less-affected leg. The added effect of the walking-specific endurance training remains unclear.