Electromyographic and kinematic nondisabled gait differences at extremely slow overground and treadmill walking speeds

This study compared the kinematic and electromyographic (EMG) gait patterns of able-bodied adults at natural speed in contrast to extremely slow overground and treadmill walking speeds. Kinematic and EMG data were collected at three speeds (self-selected, 0.30 m/s, and 0.20 m/s). Eighteen subjects were evaluated for trunk and lower-limb motion and EMG of five lower-limb muscles. Significant reductions were found in segmental motion between natural speed and both slower gait speeds, accompanied by an expected reduction in cadence and stride. EMG patterns at slower speeds showed changes in timing and reduced magnitudes. Phasic timing of the proximal muscles showed the most changes with predominant coactivation, whereas the distal muscles remained consistent with the pattern at natural self-selected speed. Overground versus treadmill gait patterns revealed minimal differences. Consideration of the effects of slower walking speed may help clinicians create interventions to target primary gait deficits on overground or treadmill walking.     

Improving spatiotemporal gait parameters in spastic diplegic children using treadmill gait training

BackgroundEven though several physiotherapy techniques help to improve the spatiotemporal gait parameters of diplegic children, the efficacy of treadmill gait training together with conventional treatment techniques on spatiotemporal parameter improvement needs more investigation.ObjectiveThis study's main purpose is to investigate the effect of treadmill gait training as an adjunct to conventional physiotherapy treatment on the spatiotemporal gait parameters of diplegic children.MethodsTwenty diplegic children were distributed randomly into two equal groups (a control group of ten children who received a traditional treatment and an experimental group of ten children who received the traditional treatment together with treadmill gait training). Gait data were collected using a Vicon three-dimensional motion analysis system during regular walking.ResultsWalking speed, cadence, step length, stride length, and single limb support were enhanced in both groups (p < 0.05). Cadence and walking speed increased by 6.5 steps/min and 0.2 m/sec respectively in the experimental group, compared to the control group. Also, step length, stride length and single limb support time increased by 0.13 m, 0.27 m, and 0.07 s respectively in the experimental group, compared to the control group.ConclusionThe use of treadmill gait training together with conventional physical therapy treatment enhances the walking performance of diplegic children by improving several spatiotemporal gait parameters. Furthermore, walking balance is improved by increasing the single-leg support time.     

Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke

BACKGROUND: Walking following stroke involves compensatory strategies by the unaffected leg to cope with the deficits in the hemiparetic leg. Recently, training paradigms based on the principles of task-oriented repetitive exercise have provided a valuable insight regarding the influence of restraining compensatory movements to improve motor performances. We investigated changes in the walking movements of each lower extremity after weighting the unaffected leg. METHODS: Ten individuals early after a stroke (range: 3-7 months) who were able to walk 10 m with no aids, participated to this study. Subjects were instructed to walk on a treadmill with an external mass attached around the non affected ankle during a single session. The short-term effects on gait performance were quantified by a 3D-gait analysis system before, immediately after and 20 min after the walking technique. FINDINGS: A one factor repeated measures model revealed that stroke participants significantly improved in walking speed (P<0.001), step length (P<0.01) and cadence (P<0.01). Weight-bearing on the paretic leg increased (P<0.01) along with kinematic modifications including greater hip and knee excursion. When the mass was removed, these adaptations were maintained 20 min later. INTERPRETATION: Preliminary findings suggest that even brief gait training using a treadmill with a restrictive weight placed on the distal extremity of the non-hemiplegic lower limb can improve laboratory measures of gait ability in a sample of stroke subjects. Future studies must evaluate the effect of this technique in longer-term locomotor retraining.     

Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study

OBJECTIVE: To study the application of partial weight-bearing (PWB) supported treadmill gait training augmented by functional electric stimulation (FES) in subjects with acute incomplete spinal cord injury (SCI). DESIGN: Before-after crossover trial with control (A) and intervention (B) periods. SETTING: Physiotherapy (PT) department of a spinal injuries unit in Scotland. PARTICIPANTS: Fourteen inpatients with acute incomplete SCI with American Spinal Injury Association class C or D injury. INTERVENTION: Training consisted of treadmill walking with PWB support augmented by FES. Subjects walked on the treadmill for up to 25 minutes a day, 5 days a week for 4 weeks. The intervention was compared with a 4-week control period in which standard PT was given. MAIN OUTCOME MEASURES: Overground walking endurance and speed, cadence, stride length, and observational gait analysis and walking speed, distance, and percentage PWB support on the treadmill. RESULTS: A greater increase in overground walking endurance was achieved after the intervention (AB group mean, 72.2m; confidence interval [CI], 39.8-104.6m; BA group mean, 63.8m; CI, -10.2 to 137.9m), as compared with after standard PT (AB group mean, 38.4m; CI, 1.8-75.0m; BA group mean, 60.1m; CI, 9.2-110.9m). A similar pattern was observed for overground walking speed. CONCLUSIONS: This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI. A larger randomized trial is required to substantiate these findings.     

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 treadmill training on gait in a hemiparetic patient

The purpose of this study was to investigate the effects of treadmill training on temporal-distance gait variables. An A-B-A treatment-withdrawal, single-subject experimental design was used on a hemiparetic patient who was 3 years post-injury. The inked footprint method was used to obtain the variables of walking velocity, cadence, base of support, stride length, and step length. Treatment was a maximum of 10 minutes on a motorized treadmill without elevation at a comfortable walking speed. Data collection for all three phases (A-B-A) and treadmill training during the treatment phase were performed three times per week for 3 weeks. Data were analyzed using a celeration line approach and a C statistic. Treatment was found to affect the base of support and right step length. An increase in symmetry between right and left step length was apparent after treadmill training. There was no effect on right or left stride length, left step length, cadence, or walking velocity. The results indicate improvement in some aspects of gait with treadmill training in the patient studied. Further research is needed to confirm the generalizability of these findings and to identify which patients might benefit from treadmill training.     

Initial development and testing of a novel foam-based pressure sensor for wearable sensing

Background

The ability to maintain a steady gait rhythm is impaired in patients with Parkinson's disease (PD). This aspect of locomotor dyscontrol, which likely reflects impaired automaticity in PD, can be quantified by measuring the stride-to-stride variability of gait timing. Previous work has shown an increase in both the variability of the stride time and swing time in PD, but the origins of these changes are not fully understood. Patients with PD also generally walk with a reduced gait speed, a potential confounder of the observed changes in variability. The purpose of the present study was to examine the relationship between walking speed and gait variability.

Methods

Stride time variability and swing time variability were measured in 36 patients with PD (Hoehn and Yahr stage 2–2.5) and 30 healthy controls who walked on a treadmill at four different speeds: 1) Comfortable walking speed (CWS), 2) 80% of CWS 3) 90% of CWS, and 4) 110% of CWS. In addition, we studied the effects of walking slowly on level ground, both with and without a walker.

Results

Consistent with previous findings, increased variability of stride time and swing time was observed in the patients with PD in CWS, compared to controls. In both groups, there was a small but significant association between treadmill gait speed and stride time variability such that higher speeds were associated with lower (better) values of stride time variability (p = 0.0002). In contrast, swing time variability did not change in response to changes in gait speed. Similar results were observed with walking on level ground.

Conclusion

The present results demonstrate that swing time variability is independent of gait speed, at least over the range studied, and therefore, that it may be used as a speed-independent marker of rhythmicity and gait steadiness. Since walking speed did not affect stride time variability and swing time variability in the same way, it appears that these two aspects of gait rhythmicity are not entirely controlled by the same mechanisms. The present findings also suggest that the increased gait variability in PD is disease-related, and not simply a consequence of bradykinesia.     

Supported treadmill ambulation training after spinal cord injury: a pilot study

OBJECTIVES: To conduct a pilot study of weight-supported ambulation training after incomplete spinal cord injury (SCI), and to assess its safety. DESIGN: Quasiexperimental, repeated measures, single group. SETTING: Veterans Affairs medical center. PATIENTS: Three subjects with incomplete, chronic, thoracic SCIs; 2 classified as D on the American Spinal Injury Association (ASIA) impairment scale and 1 as ASIA impairment scale C. INTERVENTION: Subjects participated in 12 weeks of training assisted by 2 physical therapists. The training consisted of walking on a treadmill while supported by a harness and a pneumatic suspension device. Support started at 40% of body weight and a treadmill speed of.16kmph, and progressed by reducing support and increasing treadmill speed and continuous treadmill walking time up to 20 minutes. Training was conducted for 1 hour per day, 5 days per week for 3 months. Treadmill walking occurred for 20 minutes during the sessions. MAIN OUTCOME MEASURES: Gait function (speed, endurance, walking status, use of assistive device and orthotics); oxygen costs of walking; brain motor control assessment; self-report indices; ASIA classification; muscle function test; and safety. RESULTS: All 3 subjects increased gait speed (.118m/s initially to.318m/s after training 12wk), and gait endurance (20.3m/5min initially to 63.5m/5min). The oxygen costs decreased from 1.96 to 1.33mL x kg(-1) x m(-1) after 12 weeks of training. CONCLUSIONS: This pilot study suggests that supported treadmill ambulation training can improve gait for individuals with incomplete SCIs by using objective gait measures. The self-report indices used have promise as patient-centered outcome measures of this new form of gait training. A larger, controlled study of this technique is warranted.     

Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial

OBJECTIVE: To determine whether automated locomotor training with a driven-gait orthosis (DGO) can increase functional mobility in people with chronic, motor incomplete spinal cord injury (SCI). DESIGN: Repeated assessment of the same patients or single-case experimental A-B design. SETTING: Research units of rehabilitation hospitals in Chicago; Heidelberg, Germany; and Basel and Zurich, Switzerland. PARTICIPANTS: Twenty patients with a chronic (>2 y postinjury), motor incomplete SCI, classified by the American Spinal Injury Association (ASIA) Impairment Scale with ASIA grades C (n=9) and D (n=11) injury. Most patients (n=16) were ambulatory before locomotor training. INTERVENTION: Locomotor training was provided using robotic-assisted, body-weight-supported treadmill training 3 to 5 times a week over 8 weeks. Single training sessions lasted up to 45 minutes of total walking time, with gait speed between .42 and .69 m/s and body-weight unloading as low as possible (mean +/- standard deviation, 37%+/-17%). MAIN OUTCOME MEASURES: Primary outcome measures included the 10-meter walk test, the 6-minute walk test, the Timed Up & Go test, and the Walking Index for Spinal Cord Injury-II tests. Secondary measures included lower-extremity motor scores and spastic motor behaviors to assess their potential contribution to changes in locomotor function. All subjects were tested before, during, and after training. RESULTS: Locomotor training using the DGO resulted in significant improvements in the subjects' gait velocity, endurance, and performance of functional tasks. There were no significant changes in the requirement of walking aids, orthoses, or external physical assistance. There was no correlation between improvements in walking speed or changes in muscle strength or spastic motor behaviors. CONCLUSIONS: Intensive locomotor training on a treadmill with the assistance of a DGO results in improved overground walking.     

Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors

OBJECTIVE: To explore the impact of a complex community environment on gait parameters (speed, step length and cadence) for community-dwelling participants with a previous stroke, and compare outcome measures commonly used in a clinical environment. DESIGN: Repeated measurement of participants in different environments. SETTING: One clinic and two community environments (suburban street and shopping mall). SUBJECTS: Thirty community-dwelling stroke participants with chronic stroke who were classified according to gait speed (20-50 m/min on 10-metre timed walk) as marginal community walkers. OUTCOME MEASURES: During a six-minute walk test (6MWT) a step activity monitor (SAM) and odometer were used to calculate gait speed, step length and cadence. The 10-metre timed walk (10MTW) was measured in a clinic environment. ANALYSIS: A mixed linear model examined differences in gait measurements in the different environments. Bland-Altman analysis illustrated agreement between gait speed measures (6MWT and 10MTW). RESULTS: A statistically significant, but not a clinically significant difference in gait speed between some environments was found. Gait speed was slowest in the mall and fastest in the street with a difference of only 2.1 m/min between these environments (95% confidence interval (CI) -3.8 to -0.5, P<0.01). Comparison of clinic 10MTW and street 6MWT showed wide limits of agreement (-18.5 to 16.9 m/min) which improved for clinic 6MWT and street 6MWT comparisons (-5.7 to 8.9 m/min). CONCLUSION: Despite residual gait deficit, the gait parameters of these chronic stroke survivors did not deteriorate markedly under challenging conditions. The 6MWT is recommended as a clinical measure for community ambulation.     

Comparison of angular lumbar spine and pelvis kinematics during treadmill and overground locomotion

OBJECTIVE: To determine the differences between angular oscillation curves of the lumbar spine and pelvis during walkway and treadmill ambulation. DESIGN: An in vivo observation of walking in overground and treadmill conditions. BACKGROUND: Angular movements of the lumbar spine and pelvis have been obtained during overground and treadmill walking. No data are available to indicate whether lumbar spine treadmill findings may be compared or generalized to overground readings. METHODS: Nine male subjects walked at their natural cadence along an 8 m walkway positioned over a motorized treadmill. During each of 20 walking trials, kinematic data of one full gait cycle were collected in the middle segment of the walkway. Following the overground readings the walkway was removed and treadmill recordings were taken at the subjects' preferred walking speed and at an imposed speed of 1.25 m/s. Movement patterns and maximum oscillation angles were calculated in each plane. RESULTS: Cross-correlation values of pairwise comparisons demonstrated almost comparable movement patterns between walking conditions (r > or =0.891; p<0.001) except for the movement in the sagittal plane (r=0.642, p<0.01). ANOVA for repeated measures revealed significant (p<0.05) differences in the gait cycle duration as well as reductions in oscillation amplitudes of the upper lumbar region and the pelvis in both the frontal and transverse plane during treadmill walking compared to walkway locomotion. CONCLUSIONS: Statistically significant differences exist for some angular lumbar spine movement parameters between walkway and treadmill locomotion. RELEVANCE: The observed differences between overground and treadmill locomotion should be taken in account when treadmill-based lumbar spine and pelvis kinematics want to be extended or compared to overground recordings.     

Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report

The effects of task-repetitive locomotor training on stroke patients' spatial and temporal gait parameters during unassisted walking are not well understood. This study determined the effects of treadmill aerobic exercise (T-EX) on spatial and temporal gait parameters that underlie changes in overground walking function. Thirty-nine subjects with hemiparetic stroke underwent T-EX three times weekly for 6 months. We measured the subjects pre- and posttraining on 30-foot timed walks and 6-minute distance walks with usual assistive devices and on an 8 m instrumented walkway without assistive devices. T-EX improved 30-foot walks by 17% and 6-minute walks by 23%. Unassisted walking velocity increased 22%, stride length increased 13%, and cadence increased 7%. Paretic and nonparetic step lengths increased significantly, and respective step times decreased significantly. Interlimb symmetry did not change. This study presents preliminary evidence that changes in spatial and temporal gait parameters contribute to the increased velocity of subjects with stroke after T-EX.     

Treadmill training for ataxic patients: a single-subject experimental design

OBJECTIVE: To investigate changes in gait quality, balance and mobility associated with treadmill training for ataxic individuals. DESIGN: Single-subject ABA design. Baseline phases (A) lasted three weeks and intervention (B) lasted four weeks. SETTING: University rehabilitation clinic. SUBJECTS: A woman (25 years) and a man (53 years) with chronic ataxia due to head trauma. INTERVENTION: Three 20-minute treadmill training sessions each week with progression in velocity and step length. MAIN MEASURES: Rivermead Visual Gait Assessment, Timed Up and Go, time to complete a balance task, walking speed, cadence, and stride length assessments three times a week during the 10 weeks. Data were analysed with the celeration line technique and two standard deviation band. RESULTS: Both individuals demonstrated gains in all parameters over initial baseline and subsequent phases, with performance increases ranging from 26% to 233% when first and last assessments were compared. Significantly superior effects of treadmill training over baseline conditions on cadence were detected (P<0.05). Gains in walking speed were not significantly better during intervention, but intervention withdrawal produced deceleration of performance gains. Gains in Timed Up and Go, step length and balance were not consistent and were possibly caused by a learning effect of the association between repeated testing and treadmill training. Rivermead Visual Gait Assessment gains reached significance only for subject 2 (P<0.05), probably because of increased variability of performance of subject 1. Results suggest that the association between repeated testing and treadmill training might have been responsible for the observed gains in the two ataxic patients.     

Gait impairments in persons with multiple sclerosis across preferred and fixed walking speeds

Remelius JG, Jones SL, House JD, Busa MA, Averill JL, Sugumaran K, Kent-Braun JA, Van Emmerik RE. Gait impairments in persons with multiple sclerosis across preferred and fixed walking speeds.ObjectivesTo investigate (1) whether previously observed changes in gait parameters in individuals with multiple sclerosis (MS) are the result of slower preferred walking speeds or reflect adaptations independent of gait speed; and (2) the changes in spatiotemporal features of the unstable swing phase of gait in people with MS.DesignCross-sectional study assessing changes in gait parameters during preferred, slow (0.6m/s), medium (1.0m/s), and fast (1.4m/s) walking speeds.SettingGait laboratory with instrumented walkway and motion capture system.ParticipantsMS group with mild to moderate impairment (n=19, 16 women) with a median Expanded Disability Status Scale score of 3.75 (range, 2.5–6), and a sex- and age-matched control group (n=19).InterventionsNot applicable.Main Outcome MeasuresGait speed, stride length, stride width, cadence, dual support time, swing time, and timing of swing foot and body/head center of mass during swing phase.ResultsIndividuals with MS walked at slower preferred speeds with longer dual support times compared with controls. In fixed-speed conditions, dual support times were longer and swing times were shorter in MS compared with controls. Stride width was wider for all speed conditions in the MS group. In fixed-speed conditions, the MS group positioned their head and body centers of mass closer to the anterior base of support boundary when entering the unstable equilibrium of the swing phase.ConclusionsLonger dual support time is part of a gait strategy in MS that is apparent even when controlling for the confounding effect of slower preferred speed. However, a gait strategy featuring longer dual support times may have limitations if potentially destabilizing swing dynamics exist, which especially occur at walking speeds other than preferred for people with MS.     

虚拟现实同步减重训练脑梗死患者可改善下肢运动功能

背景：脑卒中患者多有步行功能障碍,虚拟现实同步减重训练开始运用于脑梗死患者的步态训练。 目的：评估虚拟现实同步减重训练对亚急性期脑梗死患者下肢运动功能的影响。 方法：20例起病3个月内的脑梗死患者随机分配至实验组（虚拟现实同步减重训练）和常规组（常规物理治疗）。在3周步态训练前后各做一次三维步态并进行下肢运动功能评估。对以下参数进行训练前后组内和组间对比：步行速度、步调、步行时间、单腿支撑时间（%）、双腿支撑时间（%）、摆动时间、步长、步幅、下肢各关节活动度、功能性步行分类、下肢Fugl-Meyer评分和Brunel平衡评分。 结果与结论：训练前两组患者的性别、年龄、病程、偏瘫侧、步行速度、功能性步行分类、下肢Fugl-Meyer评分和Brunel平衡评分差异无显著性（P〉0.05）。训练后两组患者的下肢Fugl-Meyer评分和功能性步行分类均有改善（P〈0.05）。实验组在步行速度、步调、患侧步行时间、健侧步行时间、患侧单腿支撑时间、患侧摆动时间、健侧摆动时间、步幅、患侧步长和健侧步长的改善方面较常规组有优势。     

Abstract 21: Treadmill with partial body-weight support versus conventional gait training after stroke.

Objective: To test the hypothesis that stroke patients treated with treadmill training and partial body-weight support walk faster 90 days after stroke than patients treated with conventional gait training. Design: Block randomized, 2 treatment arm trial. Outcome measurement was performed blind to treatment group. Setting: Inpatient rehabilitation hospital. Participants: 83 patients randomized to the treadmill (n=42) or conventional (n=41) treatments within 30 days of stroke. Patients were stratified by initial walking speed (0, >0, <.25, ≥.25m/s) and stroke location (cortical, subcortical). Eligible patients had first stroke, hemiparesis, required at least contact guard to walk, and were not ataxic. Interventions: Subjects received 12 once-daily 30-minute treatments over a 3-week period and received equal study treatment time in addition to their normal therapy. Treadmill subjects started treatment with average unweighting of 30% body weight and treadmill speed set at 1.1 miles/h. Conventional treatment included standing, walking, sit to stand, standing with activity, and walking with activity. Main Outcome Measure: The primary outcome was velocity 90 days after stroke. Secondary outcomes included 6-minute walk distance, FIM™ instrument mobility subscale score, National Institutes of Health Stroke Scale score, Fugl-Meyer Assessment leg motor score, and Tinetti score. Results: All demographic, medical, and other risk factors showed no difference except for mean age (treadmill group, 69.4±10.6y vs conventional group, 62.0±12.9y). 90-day walking speed did not differ significantly (treadmill group, .71±.50m/s vs conventional group, .83±.50m/s), nor was there a difference in change in walking speed between initial measurement and 90 days. There was no significant difference in the 6-minute walk distance at 90 days or in any of the other secondary outcomes. Conclusions: Both treatment groups made improvements in walking velocity and clinical measures during rehabilitation, but treadmill training with partial body-weight support conferred no additional benefit compared with conventional training. Age may be a contributing factor to the results.     

Virtual Reality-Enhanced Partial Body Weight-Supported Treadmill Training Poststroke: Feasibility and Effectiveness in 6 Subjects

Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

Objective

To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke.

Design

A before-after comparison of a single group with BWSTT intervention.

Setting

University research laboratory.

Participants

A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study.

Intervention

Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback.

Main Outcome Measures

Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed.

Results

One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s.

Conclusions

A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.     

Immediate effect of video viewing with an illusion of walking at a faster speed using virtual reality on actual walking of stroke patients

[Purpose] The objective of this study was to provide cerebral stroke patients with virtual reality videos of gait occurring at a faster speed than their actual measured gait speed and ascertain the effect on generating errors of gait. [Participants and Methods] The participants were 12 stroke patients. They were given a 2-minute virtual reality presentation of gait occurring at a speed faster than their actual measured comfortable walking speed. Immediately following the presentation, their 10-m walking speed was measured again to observe the immediate effect of the intervention, after which the time required to walk at maximum gait speed was measured. Stride length, cadence, and walking speed before and after the intervention were compared. In addition, heard an immersive feeling. [Results] At a comfortable walking speed, the cadence improved significantly post-intervention. Walking speed and stride length also tended to increase. At the maximum walking speed, there were no significant differences in any parameter. There was no problem with the immersive feeling. [Conclusion] After watching virtual reality videos of gait at a speed faster than the patients’ actual gait speed, their walking speed tended to increase in comfortable walking. It was speculated that this technique could be applied to walking training, depending on the device.     

Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury

OBJECTIVE: To assess the effect of an intervention combining body weight support (BWS), functional electric stimulation (FES), and treadmill training on overground walking speed (OGWS), treadmill walking speed, speed and distance, and lower extremity motor scores (LEMS). DESIGN: Before and after comparison. SETTING: Miami Project to Cure Paralysis. PARTICIPANTS: Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function. INTERVENTION: Subjects trained 1.5 hours per day, 3 days per week, for 3 months. The training consisted of body weight-supported treadmill walking assisted by electric stimulation. Stimulation was applied to common peroneal nerve of the weaker lower extremity (LE) and timed to assist with the swing phase of the step cycle. MAIN OUTCOME MEASURES: OGWS in the absence of both BWS and FES; LEMS, and treadmill training parameters of speed and distance. RESULTS: Over the course of training, there was a significant increase in OGWS (from.12 +/- 0.8m/s to .21 +/- .15m/s, p = .0008), treadmill walking speed (from .23 +/- .12m/s to.49 +/- .20m/s, p = .00003), and treadmill walking distance (from 93 +/- 84m to 243 +/- 139m, p = .000001). The median LEMS increased significantly for both the stimulated and nonstimulated leg (from 8 to 11 in the FES-assisted leg, from 15 to 18 in the nonassisted leg, p < .005 for each). CONCLUSIONS: All subjects showed improvement in OGWS and overall LE strength. Further research is required to delineate the essential elements of these particular training strategies.     

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

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