An efficacy study on improving balance and gait in subacute stroke patients by balance training with additional motor imagery: a pilot study

[Purpose] The few studies conducted on subacute stroke patients have focused only on gait function improvement. This study therefore aimed to confirm the effect of balance training with additional motor imagery on balance and gait improvement in subacute stroke patients. [Subjects and Methods] Participants were divided into an experimental or control group. The experimental group received balance training for 20 minutes/day with mental imagery for 10 minutes/day, three days/week, for four weeks. The control group received only balance training for 30 minutes. Before and after the 12 sessions, balance and gait ability were assessed by the researcher and a physical therapist. [Results] After completion of the 4-week intervention, Berg Balance Scale, Timed Up and Go test, Functional Reach Test, and Four Square Step test scores significantly increased in the experimental group. In the control group, Berg Balance Scale and Functional Reach Test scores significantly improved. Changes in the Timed Up and Go test, Functional Reach Test, and Four Square Step Test scores after intervention were significantly higher in the experimental than in the control group. [Conclusion] Specific balance training with additional motor imagery may result in better rehabilitation outcomes of gait and balance ability than balance training alone.Key words: Balance, Gait, Motor imagery     

Effects of Nordic walking and walking on spatiotemporal gait parameters and ground reaction force

[Purpose] The purpose of this study was to investigate the effects of Nordic walking and walking on spatiotemporal gait parameters and ground reaction force. [Subjects] The subjects of this study were 30 young adult males, who were divided into a Nordic walking group of 15 subjects and a walking group of 15 subjects. [Methods] To analyze the spatiotemporal parameters and ground reaction force during walking in the two groups, the six-camera Vicon MX motion analysis system was used. The subjects were asked to walk 12 meters using the more comfortable walking method for them between Nordic walking and walking. After they walked 12 meters more than 10 times, their most natural walking patterns were chosen three times and analyzed. To determine the pole for Nordic walking, each subject’s height was multiplied by 0.68. We then measured the spatiotemporal gait parameters and ground reaction force. [Results] Compared with the walking group, the Nordic walking group showed an increase in cadence, stride length, and step length, and a decrease in stride time, step time, and vertical ground reaction force. [Conclusion] The results of this study indicate that Nordic walking increases the stride and can be considered as helping patients with diseases affecting their gait. This demonstrates that Nordic walking is more effective in improving functional capabilities by promoting effective energy use and reducing the lower limb load, because the weight of the upper and lower limbs is dispersed during Nordic walking.Key words: Nordic walking, Ground reaction force, Spatiotemporal 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     

Effects of gait training with horizontal impeding force on gait and balance of stroke patients

[Purpose] The purpose of this study was to investigate the effects of treadmill training with a horizontal impeding force applied to the center of upper body mass on the gait and balance of post-stroke patients. [Subjects and Methods] Twenty-four subjects with hemiplegia less than 3 months after stroke onset were randomly assigned to 2 groups: an applied horizontal impeding force on treadmill training (experimental) group (n = 12), and a control group (n = 12). Both groups walked on a treadmill at a comfortable or moderate speed for 20 minutes per day, 3 sessions per week for 8 weeks after a pre-test. The experimental group also had a horizontal impeding force applied to the center of their upper body mass. [Results] All groups demonstrated significant improvement after 8 weeks compared to baseline measurements. In intra-group comparisons, the subjects’ gait ability (CGS, MGS, cadence, and step length) and balance ability (TUG, BBS, and FRT) significantly improved. In inter-group comparisons, the experimental group’s improvement was significantly better in CGS MGS, cadence, step length, TUG, and BBS, but not in FRT. [Conclusion] Treadmill training was identified as an effective training method that improved gait and balance ability. A horizontal impeding force applied during treadmill training was more effective than treadmill walking training alone at improving the gait and dynamic balance of patients with stroke.Key words: Treadmill gait, Horizontal impeding force, Upper body     

Effects of footwear on measurements of balance and gait in women between the ages of 65 and 93 years

BACKGROUND AND PURPOSE: Footwear is not consistently standardized in the administration of the Functional Reach Test (FRT), Timed Up & Go Test (TUG), and 10-Meter Walk Test (TMW). This study was conducted to determine whether footwear affected performance on these tests in older women. SUBJECTS: Thirty-five women, aged 65 to 93 years, were recruited from assisted living facilities and retirement communities. METHODS: Each subject performed the FRT, TUG, and TMW wearing walking shoes, wearing dress shoes, and barefooted. Because of space constraints at the facilities where the testing was performed, 22 subjects performed the FRT and TUG on a linoleum floor and 13 subjects performed the tests on a firm, low-pile, carpeted floor. All 35 subjects completed the TMW on a firm, low-pile, carpeted floor. One-way repeated-measures analyses of variance (ANOVAs) and a Tukey Honestly Significant Difference test were used to compare the outcomes for the 3 footwear conditions, with separate ANOVAs conducted for the different floor surfaces for the FRT and TUG. RESULTS: Subjects performed better on the FRT when barefooted or wearing walking shoes compared with when they wore dress shoes, regardless of floor surface. Differences were found among all footwear conditions for the TUG performed on the linoleum floor and for the TMW. For these tests, the women moved fastest in walking shoes, slower barefooted, and slowest wearing dress shoes. CONCLUSION AND DISCUSSION: Footwear should be documented and should remain constant from one test occasion to another when the FRT, TUG, and TMW are used in the clinic and in research. Footwear intervention may improve performance of balance and gait tasks in older women.     

Nordic Walking在帕金森患者步态康复训练中的研究

目的:评估Nordic Walking(NW)康复训练对帕金森(PD)患者步态的改善效果.方法:40例PD患者纳入研究,随机分为对照组和NW组,各20例.对照组不给予康复训练,仅维持入组前的用药.NW组在维持入组前用药的基础上,增加NW训练,1 h/次,2次/周,共训练3个月.于治疗前及治疗3个月后,收集并比较2组的步...     

Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients

[Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.Key words: Coordination movement using the PNF pattern, Balance, Gait     

Endurance exercise training to improve economy of movement of people with Parkinson disease: three case reports

BACKGROUND AND PURPOSE: Even early in Parkinson disease (PD), individuals have reduced economy of movement. In this case report, the effects of endurance exercise training are examined on walking economy and other measures for 3 individuals in early and middle stages of PD. PATIENTS: The patients were 1 woman and 2 men with PD, aged 52 to 72 years, classified at Hoehn and Yahr stages 2 to 2.5. INTERVENTION: Each patient completed 4 months of supervised endurance exercise training and 12 months of home exercise, with monthly clinic follow-up sessions. Strategies were included to enhance adherence to exercise. OUTCOMES: The main outcome measure was economy of movement (rate of oxygen consumption during gait) measured at 4 treadmill speeds. Secondary outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Continuous-Scale Physical Functional Performance Test (CS-PFP), Functional Reach Test (FRT), and Functional Axial Rotation Test (FAR). Economy of movement improved for all 3 patients after 4 months of supervised exercise and remained above baseline at 16 months. Two patients also had scores that were above baseline for UPDRS total score, CS-PFP, FRT, and FAR, even at 16 months. DISCUSSION AND CONCLUSION:: Evidence from these 3 individuals suggests that gains may occur with a treadmill training program that is coupled with specific strategies to enhance adherence to exercise.     

Lower-extremity muscle force and balance performance in adults aged 65 years and older

BACKGROUND AND PURPOSE: Measures of postural control may be useful for determining fall risk in older people and for determining the outcomes of treatments aimed at improving balance. Commonly used tools measure the output of the postural control system. The purpose of this study was to determine the degree to which one component of postural control (muscle force) contributes to scores on 3 functional balance measures. SUBJECTS: Fifty community-dwelling volunteers between 65 and 91 years of age (mean = 74.82, SD = 6.11) participated. Based on their histories, 11 subjects were classified as being at risk for falling. METHODS: Measures were the Berg Balance Scale (BBS), the Functional Reach Test (FRT), and the Timed Get Up & Go Test (GUG). The force generated by 12 lower-extremity muscle groups was measured using a handheld dynamometer. RESULTS: In the group reporting no falls, dorsiflexor and subtalar evertor force accounted for 58% of the score on the BBS, ankle plantar-flexor and subtalar invertor force accounted for 48.4% of the score on the GUG, and ankle plantar-flexor force accounted for 13% of the score on the FRT. Ankle dorsiflexor and hip extensor forces were lower in subjects reporting falls, and force of the ankle dorsiflexors predicted fall status. CONCLUSION AND DISCUSSION: Distal muscle force measures may be able to contribute to the prediction of functional balance scores; however, the muscles involved in the prediction differ depending on the measure of balance.     

Treadmill Sideways Gait Training with Visual Blocking for Patients with Brain Lesions

[Purpose] The aim of this study was to verify the effect of sideways treadmill training with and without visual blocking on the balance and gait function of patients with brain lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in this study. They were divided into two groups: an experimental group (12 subjects) and a control group (12 subjects). [Methods] Each group executed a treadmill training session for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the treadmill was performed with visual blocking by the experimental group and with normal vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function. It was used to measure walking speed, walking distance, step length, and stance time on each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were used as balance measures. [Results] The sideways gait training with visual blocking group showed significantly improved walking speed, walking distance, step length, and stance time on each foot after training; FTSST and TUG times also significantly improved after training in the experimental group. Compared to the control group, the experimental group showed significant increases in stance time on each foot. [Conclusion] Sideways gait training on a treadmill with visual blocking performed by patients with brain lesions significantly improved their balance and gait function.Key words: Brain lesions, Treadmill training, Visual block     

The effects of stair gait training using proprioceptive neuromuscular facilitation on stroke patients’ dynamic balance ability

[Purpose] This study aims to examine stroke patients’ changes in dynamic balance ability through stair gait training where in proprioceptive neuromuscular facilitation (PNF) was applied. [Subjects and Methods] In total 30 stroke patients participated in this experiment and were randomly and equally allocated to an experimental group and a control group. The experimental group received exercise treatment for 30 min and stair gait training where in PNF was applied for 30 min and the control group received exercise treatment for 30 min and ground gait training where in PNF was applied for 30 min. For the four weeks of the experiment, each group received training three times per week, for 30 min each time. Berg Balance Scale (BBS) values were measured and a time up and go (TUG) test and a functional reach test (FRT) were performed for a comparison before and after the experiment. [Results] According to the result of the stroke patients’ balance performance through stair gait training, the BBS and FRT results significantly increased and the TUG test result significantly decreased in the experimental group. On the contrary, BBS and FRT results did not significantly increase and the TUG test result did not significantly decrease in the control group. According to the result of comparing differences between before and after training in each group, there was a significant change in the BBS result of the experimental group only. [Conclusions] In conclusion, the gait training group to which PNF was applied saw improvements in their balance ability, and a good result is expected when neurological disease patients receive stair gait training applying PNF.Key words: Proprioceptive neuromuscular facilitation, Stroke, Balance ability     

Nordic walking decreased circulating chemerin and leptin concentrations in middle-aged men with impaired glucose regulation

Abstract

Background. Dysfunction of adipose tissue is one of the major factors leading to insulin resistance. Altered adipokine concentration is an early sign of adipose tissue dysfunction. The aim of this study was to assess the impact of exercise intervention on adipokine profile, glycemic control, and risk factors of the metabolic syndrome (MeS) in men with impaired glucose regulation (IGR).

Methods. Overweight and obese men with IGR (n =144) aged 40–65 years were studied at baseline and at 12 weeks in a randomized controlled multicenter intervention study. BMI varied from 25.1 to 34.9. The subjects were randomized into one of three groups: 1) a control group (C; n =47), 2) a Nordic walking group (NW; n =48), or 3) a resistance training group (RT; n =49).

Results. Leptin concentrations decreased in the NW group compared to both other groups. Both types of exercise intervention significantly decreased serum chemerin concentrations compared to the C group. In the NW group also body fat percentage, fatty liver index (FLI), and total and LDL cholesterol concentrations decreased compared to the RT group.

Conclusions. Nordic walking intervention seems to decrease chemerin and leptin levels, and subjects in this intervention group achieved the most beneficial effects on components of MeS.     

Effects of trunk rotation induced treadmill gait training on gait of stroke patients: a randomized controlled trial

[Purpose] This study was conducted to find out the effect of arm swing during treadmill training on the gait of stroke patients. [Subjects and Methods] This study subjects were 20 stroke subjects patients who were randomly assigned to either the experimental group (EG) or the control group (CG), 10 subjects in each group. Therapists induced arm swing of affected side of EG subjects using Nordic poles, while subjects in CG had the affected arm restricted to prevent arm swing. Training was performed for 30 minutes, 3 times a week for 4 weeks. The timed up and go test (TUG), the dynamic gait index (DGI) and the 6-minute walk test (6MWT) were assessed before and after the training. [Results] After the training, there were no significant differences in the TUG times of EG and CG. There were significant differences in the DGI and the 6-minute walking distance of EG, but not of CG. There were also significant differences in the improvements of the DGI and the 6-minute walking distance between the groups. [Conclusion] Arm swing training had a positive effect on patients’ gait ability. Further studies are required to generalize the results of this study.Key words: Arm swing, Gait, Stroke     

The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance

[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients’ dynamic balance ability. [Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared. [Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant. [Conclusion] In conclusion, ramp gait training with PNF improved stroke patients’ dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.Key words: Stroke, Proprioception, Ramp gait     

The influence of a ten-week Nordic walking training-rehabilitation program on the level of lipids in blood in overweight and obese postmenopausal women

[Purpose] The aim of this study was to evaluate the effect of a ten-week Nordic Walking (NW) rehabilitation program on chosen anthropometric parameters and the level of basic lipids in overweight and obese postmenopausal women’s blood. [Subjects and Methods] The subjects were 32 women aged 50–68 (average: 59.7 ± 5.9 years). The study was carried out following a non-randomized model and entailed NW rehabilitation 5 times a week, which lasted for 10 weeks, as well as a low-calorie 1,500 kcal diet. The therapeutic results of the study were measured through changes in anthropometric and biochemical parameters. The results were subjected to a statistical analysis. [Results] After 10 weeks of NW rehabilitation it was observed that participants lost weight and their body mass index dropped. Additionally, whereas levels of total cholesterol, LDL and triglycerides dropped, and the level of HDL increased. [Conclusion] Rehabilitation carried out according to the NW model resulted in statistically significant changes in basic lipids in blood which, considerably increased the percentage of persons who achieved the recommended level of blood lipids. Obese persons were characterised by a smaller rehabilitation weight loss. More intense workouts and cooperation with a dietician are required.Key words: Nordic walking, Obesity, Blood lipids     

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.Key words: Stroke, Robotics, Gait     

Effect of hybrid assistive limb treatment on maximal walking speed and six-minute walking distance during stroke rehabilitation: a pilot study

[Purpose] In stroke rehabilitation, gait assessment measures the maximal walking speed and six-minute walking distance, both of which have not been thoroughly investigated as determinants of walking ability. Here, we assessed the methods for evaluating these gait parameters using clinical data on hybrid assistive limb treatment compared with conventional training. [Participants and Methods] In total, 20 stroke patients (hybrid assistive limb group, n=9; conventional group, n=11) participated in this randomized controlled trial. For 12 sessions (three times per week in 4 weeks), the hybrid assistive limb and conventional groups performed gait treatment with hybrid assistive limb and conventional gait training, respectively. Short physical performance battery and walking ability (maximal walking speed and six-minute walking distance) were evaluated pre- and post-intervention. Subsequently, the patients were divided further into two groups: low- and high-balance score groups. [Results] Maximum walking speed and six-minute walking distance were significantly associated, with a positive relationship observed post-intervention. The high-balance score group showed a significant improvement in the six-minute walking distance compared to the low-balance score group. However, no significant improvement in maximum walking speed was observed between both groups. [Conclusion] Due to its sensitivity in detecting differences in balance, six-minute walking distance may be a useful assessment parameter for stroke rehabilitation, particularly in the recovery of physiological walking ability.Key words: Gait assessment, Stroke rehabilitation, Hybrid assistive limb     

Effects of Nordic walking on physical functions and depression in frail people aged 70?years and above

[Purpose] This study investigated the effects of Nordic walking on physical functions and depression in frail people aged 70 years and above. [Subjects] Twenty frail elderly individuals ≥70 years old were assigned to either a Nordic walking group (n=8) or general exercise group (n=10). [Methods] The duration of intervention was equal in both groups (3 sessions/week for 12 weeks, 60 min/session). Physical function (balance, upper extremity strength, lower extremity strength, weakness) and depression were examined before and after the interventions. [Results] With the exception of upper extremity muscle strength, lower extremity strength, weakness, balance, and depression after Nordic walking demonstrated statistically significant improvement. However, in the general exercise group, only balance demonstrated a statistically significant improvement after the intervention. There were significant differences in the changes in lower extremity muscle strength, weakness and depression between the groups. [Conclusion] In conclusion, Nordic walking was more effective than general exercise. Therefore, we suggest that Nordic walking may be an attractive option for significant functional improvement in frail people over 70 years old.Key words: Nordic walking, General exercise, Frail people     

Effects of foot position of the nonparetic side during sit-to-stand training on postural balance in patients with stroke

[Purpose] We aimed to investigate postural balance after sit-to-stand (STS) training with different nonparetic foot positions in stroke patients. [Subjects] Thirty-six subjects who experienced a stroke (21 males, 15 females) participated and were divided into the symmetric foot position (SYMM), asymmetric foot position (ASYM), and step foot (STEP) groups. [Methods] Each group performed repetitive sit-to-stand training 5 times a week for 6 weeks. The timed up-and-go test (TUG), functional reach test (FRT), and F-mat system correcting the anterior/posterior (A-P) and medial/lateral (M-L) distance of the center of pressure (COP) were used to measure the static and dynamic postural balance pre- and postintervention. ANCOVA was used to analyze differences among groups, and preintervention variables were used as covariates. [Results] The TUG, FRT, and A-P and M-L distance of the COP in the ASYM and STEP groups were significantly decreased after intervention compared with the SYMM group. All parameters in the STEP group were lower than those in the ASYM group, without a significant difference. [Conclusion] The asymmetric foot position during STS is a good intervention to improve the static and dynamic postural balance in stroke patients. Especially, using a step to change the foot position is effective in improving STS performance.Key words: Foot position, Sit-to-stand, Postural balance     

Concurrent validity of the step time and walking speed obtained from the smartphone application CareCoaching in independent,community-dwelling older adults

[Purpose] In this study, we verified the validity of the step time and walking speed obtained from the smartphone gait analysis application CareCoaching. [Participants and Methods] The participants were 66 independent, community-dwelling adults aged 65 years or older who performed a 10-m walking test twice each under preferred- and slow-speed conditions. We concurrently measured gait motions using CareCoaching and the OptoGait system for reference data. Both systems compute walking speed and step time as gait parameters. We examined the concurrent validity of these parameters by using intra-class correlation coefficients (ICCs) and limits of agreement (LOAs) with Bland−Altman analyses. [Results] In the preferred walking speed condition, the ICCs of walking speed and step times between the CareCoaching and the OptoGait system were 0.67 and 0.93, respectively. In the slow walking speed condition, the ICCs for walking speed and step time were 0.78 and 0.97, respectively. In addition, the LOAs for step time were −0.0941 to 0.1160 for preferred walking speed and −0.0596 to 0.0883 for slow walking speed. The LOAs for walking speed were −0.4158 to 0.0568 for preferred walking speed and −0.3348 to 0.0523 for slow walking speed. [Conclusion] CareCoaching showed excellent agreement for step time and moderate-to-good agreement for walking speed in independent, community-dwelling older adults.