Effect of robotic locomotor training in an individual with Parkinson's disease: a case report

Purpose.?The purpose was to test the effect of robot-assisted gait therapy with the Lokomat system in one representative individual with Parkinson's disease (PD).

Methods.?The patient was a 67-year-old female with more than an 8-year history of PD. The manifestations of the disease included depressive mood with lack of motivation, moderate bradykinesia, rigidity and resting tremor, both involving more the right side of the body, slow and shuffling gait with episodes of freezing and risk of falling. The patient underwent six sessions of robot-assisted gait training. The practice included treadmill walking at variable speed for 25–40?min with a partial body weight support and assistance from the Lokomat orthosis.

Results.?After the therapy, the patient increased the gait speed, stride length and foot clearance during over ground walking. She reduced the time required to complete a 180° turn and the latency of gait initiation. Improvements were observed in some items of the Unified Parkinson's Disease Rating Scale including motivation, bradykinesia, rigidity, freezing, leg agility, gait and posture.

Conclusions.?Although the results supported the feasibility of using robot-assisted gait therapy in the rehabilitation an individual with PD, further studies are needed to assess a potential advantage of the Lokomat system over conventional locomotor training for this population.     

The effects of visual cues from optical stimulation devices on gait disturbance in patients with Parkinson’s disease

[Purpose] The purpose of this study was to identify the optimal visual cues for gait disturbance in patients with Parkinson’s disease based on the luminous duration and the individual patient preferences for a wearable visual cue device. [Participants and Methods] Twenty-four patients with Parkinson’s disease walked while wearing only a visual cue device in the control condition. They then walked while the device was set to two stimulus conditions: the luminous duration at 10% and 50% of the individual gait cycle. After walking under the two stimulus conditions, the patients were asked for their preferred visual cue condition. The walking results were compared between the two stimulus conditions and the control condition. Gait parameters were compared among the three conditions. The comparisons with preference, non-preference, and control conditions were also made for the same gait parameter. [Results] When compared to the control condition, walking with visual cues in the stimulus conditions reduced stride duration and increased cadence. The preference and non-preference conditions had shorter stride durations than the control condition. Furthermore, the preference condition also resulted in a faster gait speed than the non-preference condition. [Conclusion] This study suggests that a wearable visual cue device with the patient’s preferred luminous duration may help manage gait disturbance in patients with Parkinson’s disease.     

Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors

Purpose.?To establish the feasibility and effectiveness of a community-based exercise programme for ambulatory patients with stroke discharged from rehabilitation

Method.?Eighteen participants were recruited 3–12 months after onset of first stroke. Using a time series experimental design, the group completed a baseline period of 4 weeks (A1), a group exercise programme of low-intensity progressive resistive exercise and functional tasks for lower limb muscles (B) and repeat assessment after cessation of exercise (A2). Fitness instructors delivered sessions at Leisure Centres twice weekly for 14 weeks with physiotherapy support and the minimum attendance requirement was 16 sessions. Measures included muscle strength, gait velocity, Berg Balance Scale and Nottingham Extended Activities of Daily Living.

Results.?Lower limb muscle strength improved after training (ANOVA, p?<?0.02). Paretic knee extension strength increased from 43.4?±?5.9 to 60.4?±?6.8 Nm after 16 exercise sessions. Walking velocity increased significantly (ANOVA, p?<?0.001), from 0.54?±?0.07 to 0.75?±?0.08 m/s (t?=??3.31, p?<?0.01). Balance and everyday function were also significantly improved (p?<?0.003). There were marked individual variation in the response to training, and those who completed additional training did not show benefit.

Conclusions.?This community-based exercise programme was feasible and delivered positive improvements in physical function for participants. Further issues raised for investigation include the individual response to training and the benefits of extended training.     

Gait changes with walking devices in persons with Parkinson’s disease

Purpose: To study immediate gait changes in persons with PD when walking with different assistive walking devices. Methods: Ten individuals with idiopathic PD participated in the study. Gait parameters were recorded while walking with a cane and a wheeled walker, and were compared to a free walk without a walking device. Results: Persons with PD walked with slower gait speed when using a cane and a wheeled walker compared to walking without any device (p?=?0.007, p?=?0.002, respectively). Stride length reduced significantly when walking with a wheeled walker (p?=?0.001). Walking with the assistive devices did not affect cadence, double support phase, heel to heel base of support, stride time, and stance period. Conclusion: Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. The results may lead to more cautious clinical practice in gait rehabilitation using ambulatory assisted devices.

Implications for Rehabilitation

• Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker.

• Clinicians should be cognizant of these modifications during gait rehabilitation using ambulatory assisted devices.

     

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.     

The effect of a training program combined with augmented afferent feedback from the feet using shoe insoles on gait performance and muscle power in older adults: a randomised controlled trial

Background.?Aged-related loss of afferent feedback of the feet plays an important role in gait performance. Although strength, balance and gait training can significantly improve the muscle power and functional abilities of older individuals, it remains unclear whether training effects can be enhanced by augmenting afferent feedback from the feet adding shoe insoles complementary to conventional training.

Objective.?The current study investigated the effect of physical exercise combined with wearing MedReflex® shoe insoles on the gait performance and muscle power in older adults.

Methods.?Twenty-eight independent living, older adults aged 65–91 years were randomly assigned to either an insole group (IG; n?=?14) or a training group (TG; n?=?14). Further 14 subjects matched to the IG and TG were recruited as a control group (CG; n?=?14) (no exercise). The IG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas, the IG wore the insoles during everyday life and during training sessions. Assessments included the Falls Efficacy Scale – International (FES-I), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training.

Results.?There were significant time?×?group interactions in walking speed, step length and in several muscle power measurements. The positive effects of gait parameters ranged between 1% and 12% and between 1% and 8% and the trend to improvements of muscle power ranged between 15–79% and 20–79% for the IG and TG, respectively. The IG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0% and??5% for gait parameters and between??4% and??14% for muscle power. No significant change in FES-I score occurred in neither groups.

Conclusions.?The results of this study provide evidence of significant improvements in gait performance and muscle power after a conventional training program in independent living, older adults. However, there is no additional effect of long-term adaptation of gait caused by wearing insoles concurrent to physical training.     

Group aquatic training improves gait efficiency in adolescents with cerebral palsy

Purpose.?To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system.

Method.?Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45?min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions' intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function.

Results.?Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures.

Conclusions.?Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.     

Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke

Purpose.?To evaluate the clinical efficacy of functional electrical stimulation (FES) therapy of the tibialis anterior (TA) muscle on gait restoration and enhancing motor recovery with stroke patients.

Method.?Thirty hemiparetic participants with spastic foot-drop impairments who were at least 3 months post-stroke were recruited from a rehabilitation institute and were assigned either to a control group or a FES group. Both the groups participated in a conventional stroke rehabilitation program for 60?min per day, 5 days a week, for 12-weeks. The FES group received the electrical stimulation to the TA muscle for correction of foot-drop.

Results.?Functional electric stimulation (FES) resulted in a 26.3% (p?<?0.001) improvement of walking speed measured with 10-m walkway, whereas the improvement in the control group was only 11.5% (p?<?0.01). The FES group also showed significantly greater improvements compared to control group in other gait parameters (e.g. cadence, step length), physiological cost index (PCI), ankle range of motion, spasticity of calf muscle, Fugl–Meyer scores, and the maximum value of the root mean square (RMS_max), which reflects the capacity of the muscle output.

Conclusions.?These findings suggest that, the FES therapy combined with conventional therapy treatment more effectively improves the walking ability and enhances the motor recovery when compared with conventional therapy alone in stroke survivors.     

An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis

Aim: In this single blind randomized controlled trial, we examined the effect of a virtual reality-based training on gait of people with multiple sclerosis.

Methods: Twenty-five individuals with multiple sclerosis with mild to moderate disability were randomly assigned to either the control group (n?=?11) or the experimental group (n?=?14). The subjects in the control group received treadmill training. Subjects in the experimental group received virtual reality based treadmill training. Clinical measures and gait parameters were evaluated.

Result: Subjects in both the groups significantly improved the walking endurance and speed, cadence and stride length, lower limb joint ranges of motion and powers, during single and dual task gait. Moreover, subjects in the experimental group also improved balance, as indicated by the results of the clinical motor tests (p?Conclusion: Our results support the perceived benefits of training programs that incorporate virtual reality to improve gait measures in individuals with multiple sclerosis.

• Implication of rehabilitation

• Gait deficits are common in multiple sclerosis (85%) and worsen during dual task activities.

• Intensive and progressive treadmill training, with and without virtual reality, is effective on dual task gait in persons with multiple sclerosis.

• Virtual reality-based treadmill training requiring obstacle negotiation increases the range of motion and the power generated at the hip, consequently allowing longer stride length and, consequently, higher gait speed.

     

Effects of training and detraining on the static and dynamic balance in elderly fallers and non-fallers: A pilot study

Purpose.?The aim of this study was to evaluate the effects of training based on static and dynamic balance in single and dual task conditions in order to analyse the effects of detraining on static and dynamic balance in healthy elderly fallers and non-fallers.

Method.?A group of 16 subjects were trained: eight fallers aged 71.1 ± 5.0 years and eight non-fallers aged 68.4 ± 4.5 years. The subjects were evaluated 3 months before the training period, 2 days before the training period, 2 days after the end of the training period and 3 months after the training period. All subjects performed a unipedal test with eyes open and eyes closed. Gait parameters were analysed under single-task and dual motor-task conditions.

Results.?This study demonstrated a loss of physical capacities over 3 months for stride time, single support time for fallers in both conditions. Physical training significantly improves static and dynamic balance under single and dual task conditions. Lastly, after 3 months of detraining, a loss of the physical training effects were measured for fallers and non-fallers on the different walking parameters in the two conditions and on the unipedal tests.

Conclusions.?The absence of stimulation before the trained period shows a negative effect of ageing on walking and falls whereas training permits an improvement in static balance and the pattern of walking under single and dual task conditions, which could be due to an increase in muscular strength and a better division of attention. On the other hand, 3 months of detraining inhibited the effects of training, which showed the speed of the decline caused by ‘natural’ ageing.     

The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy

Purpose.?To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines.

Method.?Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0° with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period.

Results.?AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking.

Conclusion.?The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.     

Rehabilitation of postural stability in ataxic/hemiplegic patients after stroke

Purpose.?This study assesses the postural stability and the effect of balance training using a force platform visual biofeedback among outpatients with postural disturbances following stroke.

Method.?A tilting multiaxial force platform was used to assess bilateral postural stability in 38 outpatients (mean age 69.50?±?8.57 years) with hemiplegia and/or ataxia after stroke. Stability indexes were obtained. Afterwards, a subgroup of 12 patients with the poorest overall stability index (OASI) started a balance training programme in the force platform. Postural control training consisted of a 30-min training session once a week for a 15-week period. The test was then repeated.

Results.?In the 38 outpatients sample, the mean OASI was 4.7?±?2.0 and 42.1% of the patients used their hands for support. In the 12 outpatients group, the initial OASI was 5.8?±?2.3 and half of the patients used their hands for support. The final OASI was 3.3?±?1.0 (p?=?0.005) and only two of the patients used their hands for support (p?=?0.046).

Conclusion.?Our results suggest that a training programme using force platform visual biofeedback improves objective measures of bilateral postural stability in patients with hemiplegia and/or ataxia after stroke.     

Effects of 12-week supervised treadmill training on spatio-temporal gait parameters in patients with claudication

The purpose of the study was to evaluate selected temporal and spatial gait parameters in patients with intermittent claudication after completion of 12-week supervised treadmill walking training. The study included 36 patients (26 males and 10 females) aged: mean 64 (SD 7.7) with intermittent claudication. All patients were tested on treadmill (Gait Trainer, Biodex). Before the programme and after its completion, the following gait biomechanical parameters were tested: step length (cm), step cycle (cycle/s), leg support time (%), coefficient of step variation (%) as well as pain-free walking time (PFWT) and maximal walking time (MWT) were measured. Training was conducted in accordance with the current TASC II guidelines. After 12 weeks of training, patients showed significant change in gait biomechanics consisting in decreased frequency of step cycle (p?p?p?p?p?p?>?0.05).

• Implications for Rehabilitation

• Twelve-week treadmill walking training programme may lead to significant improvement of temporal and spatial gait parameters in patients with intermittent claudication.

• Twelve-week treadmill walking training programme may lead to significant improvement of pain-free walking time and maximum walking time in patients with intermittent claudication.

     

Effects of low frequency functional electrical stimulation with 15 and 50 Hz on muscle strength in heart failure patients

Purpose.?To compare the acute effects of functional electrical stimulation (FES) with 15 and 50 Hertz (Hz) frequencies on muscle strength in patients with heart failure with healthy individuals.

Methods.?Twenty-two 61.6?±?1.0 y-old male volunteers were studied: 10 patients with heart failure (functional class II-III) and 12 healthy controls. The isometric muscle peak torque (IMPT) of the quadriceps femoral muscle was measured through a Biodex dynamometer in maximum voluntary contraction (MVC), and under FES of 50?Hz and 15?Hz, which was applied with a 0.4?ms pulse width, 10-s contraction time, 50- s resting time and maximum tolerable intensity.

Results.?The IMPT differed in MVC, 50?Hz and 15?Hz FES both in patients (201.9?±?14, 55.6?±?13 and 42.1?±?12 Newton-metre, respectively; p?<?0.001) and in controls (179.3?±?9, 62.4?±?8 and 52.3?±?7 Newton-metre, respectively; p?<?0.001). There were no differences between the groups. In patients and controls, respectively, the 50?Hz FES corresponded to 27% versus 35% and the 15?Hz to 21% versus 29% of the IMPT generated at the MVC (p?<?0.001).

Discussion.?This result can be attributed to the fact that muscle strength is proportional to the stimulation frequency and to the number of recruited motor units. Thus, the higher the frequency, the greater the motor recruiting, producing increased muscle strength.

Conclusion.?The IMPT generated by acute 50?Hz application of FES is higher than the one generated by 15?Hz, but it is lower than MVC in controls and patients with heart failure.     

Influence of fear of falling on gait and balance in Parkinson’s disease

Abstract

Purpose: To study the relationship of fear of falling (FoF) with gait characteristics and balance in individuals with Parkinson's disease (PD). Method: Seventy-nine non-demented individuals (62 males) with PD were studied. Their mean age was 69.22?±?8.93 years. The average time since diagnosis was 8.27?±?5.31 years. FoF was assessed by the Activities-specific Balance Confidence (ABC) Scale in which high scores indicate less FoF. Gait was measured using a computerized walkway. Balance was measured by timed tests including the 5-step test, 360 degree turn, timed sideways walk, and timed up and go test. Participants were divided into two groups based on their ABC score (high FoF, ABC score <69; low FoF, ABC score ≥69). Gait characteristics and balance measures of the two groups were compared. Results: Gait speed and stride length for forward walking (p?<?0.0005 for both) and backward walking (p?=?0.001 and 0.002, respectively) were lower for those with a high level of FoF compared to those with a low level of FoF. The time to take five steps (p?=?0.025), time to turn (p?<?0.0005), time to walk sideways (p?=?0.001), and time to complete the up and go test (p?=?0.003) were longer in those with a high level of FoF than in those with a low level of FoF. Number of steps to complete the turn (p?=?0.001) and steps to walk sideways (p?=?0.002) were greater in those with a high level of FoF than in those with a low level FoF. Conclusions: Gait and balance of individuals with PD with a high level of FoF were poorer than those with a low level of FoF, regardless of previous fall history.

• Implications for Rehabilitation

• The results demonstrates that fear of falling (FoF) is related to gait and balance in individuals with PD.

• Clinicians should be aware that FoF has a negative impact on gait and balance in individuals with PD.

     

Design and analysis of an original powered foot clearance creator mechanism for walking in patients with spinal cord injury

Background: The aim of this study was to assess the performance of an original powered foot clearance creator (PFCC) mechanism worn in conjunction with an isocentric reciprocal gait orthosis (IRGO) and evaluate its effect on trunk compensatory movements and spatiotemporal parameters in nine healthy subjects.

Method: A PFCC motorized mechanism was designed that incorporated twin sole plates, the movements of which enabled increased toe to floor clearance during swing phase. A prototype was constructed in combination with an IRGO, and hence was re-named as an IRGO-PFCC orthosis. The effects of IRGO-PFCC usage on the spatiotemporal parameters and trunk compensatory movements during walking were then analyzed under two conditions, firstly with the PFCC ‘active’ i.e., with the motorized device functioning, and secondly inactive, where floor clearance was standard.

Results: Ambulating with IRGO-PFCC orthosis resulted in reduction in the spatiotemporal parameters of gait (speed of walking, cadence and stride length) in nine healthy subjects. Walking with IRGO-PFCC orthosis led to significant differences in lateral (p?=?.007) and vertical (p?=?.008) trunk compensatory movements. In other words, through using IRGO-PFCC orthosis, the lateral and vertical trunk compensatory movements decreased by 51.32% and 42.7%, respectively.

Conclusion: An adapted PFCC mechanism, with a relatively small motor and power supply could effectively increase toe to floor clearance during swing phase and thereby decrease trunk compensatory motions and potentially improve energy consumption.

• Implications for rehabilitations

• ?The High rejection rates of reciprocal gait orthoses are related to the increasing in energy expenditure and burden loads on the upper limb joints during walking following trunk compensatory movements.?An original powered foot clearance creator mechanism was designed and constructed to assisting floor clearance capability and reduce trunk compensatory movements in subjects with spinal cord injury during swing phase of gait.?This original powered foot clearance creator mechanism by using moveable soleplates and motorized actuation could decrease the trunk compensatory motions during the ambulation of nine healthy subjects.?More experiments are needed to investigate this mechanism on trunk compensatory movements of SCI subjects.

     

Effects of modified constraint-induced movement therapy on the lower extremities in patients with stroke: a pilot study

Purpose: This study aimed to qualify the improvements of modified constraint-induced movement therapy (m-CIMT) on the lower limb of stroke patients via assessing the centre of mass (COM) displacement and the basic gait parameters.

Methods: A total of 22 hemiplegic patients after stroke with first-time clinical cerebral infarction or haemorrhagic cerebrovascular accident were included in this study from May to December, 2014. The patients were randomly divided into m-CIMT group and the conventional therapy group (control group), and received corresponding training for five days/week for four weeks. The COM displacement and gait parameters were assessed by three-dimensional segmental kinematics method in pre-intervention and post- intervention therapy.

Results: After four weeks of m-CIMT, the COM displacement on sagittal plane of paretic leg during stance phase was increased (pre: 91.04?±?4.39?cm, post: 92.38?±?4.58?cm, p?p?p?Conclusion: The m-CIMT intervention improves the COM displacement in sagittal and frontal plane, as well as gait parameters. These suggest that m-CIMT intervention may be feasible and effective for the rehabilitation of hemiplegic gait.

• Implications for Rehabilitation

• Segmental kinematics method was used to estimate the displacement of the COM.

• m-CIMT interventions improved the COM displacement of patients after stroke.

• m-CIMT interventions improved the hemiplegic gait parameters.

     

Effects of a novel walking training program with postural correction and visual feedback on walking function in patients with post-stroke hemiparesis

[Purpose] This study aimed to elucidate the effects of a novel walking training program with postural correction and visual feedback on walking function in patients with post-stroke hemiparesis. [Subjects] Sixteen subjects were randomly allocated to either the experimental group (EG) or the control group (CG), with eight subjects in each. [Methods] EG and CG subjects performed a 30-min treadmill walking training exercise twice daily for 2 weeks. EG subjects also underwent postural correction using elastic bands and received visual feedback during walking. The 10-m walk test was performed, and gait parameters were measured using a gait analysis system. [Results] All parameters showed significant main effects for the group factor and time-by-group interactions. Significant main effects for the time factor were found in the stride length and stance phase ratios. [Conclusion] The novel walking training program with postural correction and visual feedback may improve walking function in patients with post-stroke hemiparesis.Key words: Postural correction, Stroke, Walking function     

Clock drawing and rehabilitation outcome in hip fracture patients

Purpose.?To assess the relationship between the Clock Drawing Test (CDT) and rehabilitation outcome in hip fracture patients within normal range of the Mini Mental State Examination (MMSE).

Methods.?This retrospective study was performed in a post-acute geriatric rehabilitation centre. One hundred and forty-two patients with proximal hip fracture admitted from January 2006 to June 2008 whose MMSE scores was within normal range (>23) were enrolled in the study. The patients were divided into two groups according to CDT performance (impaired versus intact). The differences between the two groups in relation to age, gender, education level, living arrangement, pre fracture functional level, fracture type, and outcome measurements [Functional Independent Measure (FIM), motor FIM, Rate of in-hospital Improvement (RI) in FIM and motor FIM, and Length of Stay (LOS)] were assessed.

Results.?Discharge FIM score and motor FIM scores were significantly lower for the impaired CDT group (89?±?13.7 vs. 94.9?±?11.6, p?=?0.007; 61.6?±?11.1 vs. 65.7?±?9.6, p?=?0.022 respectively); LOS was significantly longer (28.2?±?7.9 vs. 25.3?±?8.5, p?=?0.033) and rates of improvement in FIM and motor FIM were significantly slower (0.62?±?0.35 vs. 0.77?±?0.45, p?=?0.036; 0.61?±?0.34 vs. 0.75?±?0.42, p?=?0.033, respectively). Nevertheless, FIM and motor FIM scores changes were similar in both CDT groups. Following adjustment for age, LOS of patients with impaired CDT was significantly longer (p?=?.027).

Conclusions.?The CDT may assist the multidisciplinary team in identifying hip fracture patients whose MMSE scores are within the normal range, but yet need a longer training period to extract their rehabilitation potential.