Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial

Purpose: The aim of the study was to compare the efficacy of Nordic pole walking (NPW) training with traditional treadmill training (TT) on a claudication (CD) and maximum walking distance (MWD) in patients with peripheral arterial disease (PAD). Method: Patients with intermittent claudication (IC) (n?=?70; age=68.27) in the Fontaine class II were randomized into a two three-month rehabilitation programs performed three times per week. TT were finished by 31 patients, NPW by 21. Walking capacity was measured by an exercise treadmill test (ETT) with the Gardner–Skinner protocol (before and after the program) and six minute walk test (6MWT) (before, during and after the program). Results: In an ETT both groups reached significant increase in CD and MWD (p?≤?0.005). In 6MWT NPW group reached significant increase in both CD (p?=?0.001) and MWD (p?=?0.001), whereas the TT group only in MWD (p?=?0.001). Conclusions: NPW has been shown to be as effective as the standard TT and is much less expensive. It should be the preferred method of exercise for PAD patients with IC.

• Implications for Rehabilitation

• Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease (PAD) patients with intermittent claudication (IC).

• Nordic walking has been shown to be as efficient as traditional treadmill training. It is however more cost-effective method of rehabilitation in PAD patients.

     

Experimental model of pain-free treadmill training in patients with claudication

OBJECTIVE: Treadmill training in claudication is often based on walking exercise to a pain threshold or longer to the maximum muscle pain of the lower limbs. This kind of exercise may cause an inflammatory response. The purpose of this study was to determine whether pain-free treadmill training using walking exercise to 85% of the distance to onset of claudication pain can significantly improve pain-free walking distance in patients with intermittent claudication and to evaluate whether this kind of program may induce an inflammatory response leading to the progression of atherosclerosis. DESIGN: A total of 98 patients aged 50-70 yrs with stable intermittent claudication were randomized into a supervised treadmill training program or a comparison group. Patients in the treatment group participated in 12 wks of supervised treadmill training. We examined the effects of 12 wks of pain-free treadmill training on pain-free walking distance, total leukocyte count, neutrophil count, and microalbuminuria in patients with claudication. RESULTS: A total of 80 participants completed the program. Exercise rehabilitation increased the time to onset of claudication pain by 119.2%, from 87.4 +/- 38 m to 191.6 +/- 94.8 m (P < 0.001). There was no increase in total leukocyte count, neutrophil count, or microalbuminuria after 12 wks of treadmill exercise (P > 0.05) CONCLUSION: A pain-free training program can be used in the treatment of claudication as a low-risk program, increasing walking ability without potential harmful effects of ischemia-reperfusion injury.     

The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication

Background

The management of peripheral arterial disease with intermittent claudication includes angioplasty, pharmaceutical therapy, risk factor modification and exercise therapy. Supervised exercise programmes are used sporadically but may improve the distance that an individual with claudication can walk. The purpose of this study was to evaluate the effectiveness of a 3-month supervised exercise programme on improving gait parameters in patients with intermittent claudication.

Methods

12 participants were recruited (mean (SD) — age: 67.3 (6.8) years, height: 1.67 (0.09) m, mass: 79.4 (14.0) kg, ankle brachial pressure index: 0.73 (0.17)) from the local vascular unit and enrolled in a supervised exercise programme. Kinematic and kinetic data were collected at the following time points: pain-free walking, initial claudication pain, absolute claudication pain and after a patient-defined rest period. Data were collected before and after the 3-month supervised exercise programme.

Findings

No significant differences were found in any of the gait parameters post-intervention including pain-free walking speed (P = 0.274), peak hip extension (P = 0.125), peak ankle plantarflexion (P = 0.254), or first vertical ground reaction force peak (P=0.654). No significant gait differences were found across different levels of pain pre- or post-intervention.

Interpretation

The lack of improvement post-intervention observed suggests that the current exercise protocol was not tailored to elicit significant improvements in patients with intermittent claudication, specifically. The results indicate that exercise programmes may show improved results post-intervention if they are longer in duration and varied in intensity. Further research into more detailed muscle and biomechanical adaptations is needed to inform exercise programmes specific to this population.     

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.

     

Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

Purpose: We investigated if 30?min of daily treadmill training with an incline for 6 weeks would reduce ankle joint stiffness and improve active range of movement in adults with cerebral palsy (CP).

Methods: The study was designed as a randomized controlled clinical trial including 32 adults with CP (GMFCS 1–3) aged 38.1 SD 12 years. The training group (n?=?16) performed uphill treadmill training at home daily for 30?min for 6 weeks in addition to their usual activities. Passive and reflex mediated stiffness and range of motion (ROM) of the ankle joint, kinematic and functional measures of gait were obtained before and after the intervention/control period. Intervention subjects trained 31.4 SD 10.1 days for 29.0 SD 2.3?min (total) 15.2?h.

Results: Passive ankle joint stiffness was reduced (F?=?5.1; p?=?0.031), maximal gait speed increased (F?=?42.8, p?F?=?5.3, p?F?=?12.5; p?Conclusion: Daily treadmill training with an incline for 6 weeks reduces ankle joint stiffness and increases active ROM during gait in adults with CP. Intensive gait training may thus be beneficial in preventing and reducing contractures and help to maintain functional gait ability in adults with CP.

• Implications for rehabilitation

• Uphill gait training is an effective way to reduce ankle joint stiffness in adult with contractures.

• 6 weeks of daily uphill gait training improves functional gait parameters such as gait speed and dorsal flexion during gait in adults with cerebral palsy.

     

Home-Based Treadmill Training to Improve Gait Performance in Persons With a Chronic Transfemoral Amputation

Objective

To investigate the effectiveness of a home-based multiple-speed treadmill training program to improve gait performance in persons with a transfemoral amputation (TFA).

Design

Repeated measures.

Setting

Research laboratory.

Participants

Individuals with a TFA (N=8) who had undergone a unilateral amputation at least 3 years prior as a result of limb trauma or cancer.

Intervention

Home-based treadmill walking for a total of 30 minutes a day, 3 days per week for 8 weeks. Each 30-minute training session involved 5 cycles of walking for 2 minutes at 3 speeds.

Main Outcome Measures

Participants were tested pretraining and after 4 and 8 weeks of training. The primary measures were temporal-spatial gait performance (symmetry ratios for stance phase duration and step length), physiological gait performance (energy expenditure and energy cost), and functional gait performance (self-selected walking speed [SSWS], maximum walking speed [MWS], and 2-minute walk test [2MWT]).

Results

Eight weeks of home-based training improved temporal-spatial gait symmetry at SSWS but not at MWS. A relative interlimb increase in stance duration for the prosthetic limb and proportionally greater increases in step length for the limb taking shorter steps produced the improved symmetry. The training effect was significant for the step length symmetry ratio within the first 4 weeks of the program. Energy expenditure decreased progressively during the training with nearly 10% improvement observed across the range of walking speeds. SSWS, MWS, and 2MWT all increased by 16% to 20%.

Conclusions

Home-based treadmill walking is an effective method to improve gait performance in persons with TFA. The results support the application of training interventions beyond the initial rehabilitation phase, even in individuals considered highly functional.     

Nordic walking for geriatric rehabilitation: a randomized pilot trial

Purpose: There is a need to identify effective interventions to promote walking capacity in seniors. This study compares nordic walking (NW) and usual overground walking (OW) and estimates the relative efficacy in improving walking capacity (endurance and gait speed) of the elderly. Method: Single blind, site-stratified, randomized, pilot trial designed to estimate the amount of change with NW and OW. Main outcomes were distance walked measured by 6-min walk test (6MWT) and comfortable gait speed measured by 5-meter walk test (5MWT). Explanatory variables were age, sex, number of comorbidities, walking aids, balance, pain, and leg function. Results: NW and OW participants improved, respectively, 45 and 41 m on 6MWT and increased their gait speed by 0.14 and 0.07 m/s, respectively. NW effect sizes were moderate for 6MWT (ES = 0.53) and large for gait speed (effect size (ES) = 0.68). OW demonstrated moderate effect size for 6MWT (ES = 0.53) but a small one for gait speed (ES = 0.33). Relative efficacy, which was obtained from the ratio of NW and OW effects’ sizes, was 1 for 6MWT and 2.06 for gait speed. Conclusions: NW is 106% more effective in improving gait speed among elderly than OW.

Implications for Rehabilitation

• Elderly are the fastest growing segment of the population. With advanced age, greater number of disabilities, and consequently mobility limitations, are observed among this group.

• Nordic walking is a more intensive form of walking, using muscles of upper and lower body. There’s evidence that nordic walking leads to greater cardiorespiratory workload without an increase in the level of exertion.

• In this study, nordic walking was 106% more efficient than regular walking in improving gait speed among the elderly.

• Clinicians specialized in geriatric rehabilitation may contribute to improve gait speed of seniors by adding nordic walking, a non-expensive and feasible option, to their physiotherapy sessions.

     

Effects of intermittent claudication due to arterial disease on pain-free gait

IntroductionStudies of intermittent claudication gait report inconsistent outcomes. Changes in gait are often attributed to degradation of calf muscles, but causation has not been proven through real-time electromyographic data. Neither have effects of walking speed been fully considered. This study aimed to investigate the effect of intermittent claudication on kinematics, kinetics and muscle activity during pain-free gait.Methods18 able bodied individuals and 18 with intermittent claudication walked at their preferred speed while lower limb kinematic, kinetic and electromyography data were collected.FindingsPeople with intermittent claudication walk slower and with reduced step length. Internal ankle plantarflexion moment (P = 0.004, effect size = 0.96) and ankle power generation (P < 0.001, effect size = 1.36) in late stance were significantly reduced for individuals with intermittent claudication. Significant moment and power reductions at the knee and power reduction at hip occurred in early stance, with similar reductions in early and late stance for ground reaction forces. Peak electromyography of soleus activity was significantly reduced in late stance (P = 0.01, effect size = 1.1, n = 13). Effects were independent of walking speed.InterpretationReductions in ankle plantarflexion moments and power generation were consistent with reduced soleus electromyography activity and reduced peak vertical ground reaction forces during late stance. These effects are not due to a reduced walking speed. Changes in knee and hip function are also unrelated to walking speed. These outcomes provide a platform for the design and evaluation of interventions that seek to restore normal walking and improve pain-free walking distances for people with intermittent claudication.     

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.

     

Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis

Purpose: The aim of this study was to examine the effect of 6?min of walking on fatigue, exertion and spatiotemporal, kinematic and kinetic gait parameters in people with multiple sclerosis (MS). Methods: Thirty-four people with MS with moderate levels of disability completed measures of fatigue, exertion and instrumented gait analysis before and after 6-min trials of rest and walking (using a modified 6-min walk test, m6MWT). Ten age- and gender-matched healthy controls completed analysis before and after the m6MWT. Results: The MS group had a significant increase in self-reported fatigue following the m6MWT; however, there was no effect on spatiotemporal gait parameters. During stance on the more affected side ankle dorsiflexion at initial contact decreased, while knee and hip flexor moments and hip power absorption increased. On the less affected side ankle and knee power absorption, and hip extensor moment all increased. Healthy controls showed increases in joint kinetics likely due to increased walking speeds following m6MWT. Conclusion: For people with MS, ankle dorsiflexion angle reduces at initial contact following walking induced fatigue, while increased power absorption at the hip, knee and ankle indicate gait inefficiencies that may contribute to higher levels of fatigue and exertion.

• Implications for Rehabilitation

• The modified 6-min walk test (m6MWT) leads to significant increases in self-reported fatigue and exertion in people with MS.

• Following the m6MWT, there is significantly reduced ankle dorsiflexion angle at initial contact in the more affected leg in people with MS. This reveals an important walking-induced kinematic change that should be the target of future orthotic and strengthening interventions.

• In people with MS, increased power absorption primarily during the stance phase of gait following the m6MWT reveals important walking-induced muscle weakness that should also be monitored in future strengthening and gait retraining interventions.

     

功能性电刺激结合快速步行训练对脑卒中偏瘫患者功能的影响

目的:观察功能性电刺激结合快速步行训练对脑卒中偏瘫后遗症期患者社区性步行能力及生理耗能的影响。方法:将30例脑卒中偏瘫足下垂患者随机分为观察组和对照组各15例,均接受神经内科常规药物及康复功能训练;观察组采用功能性电刺激(FES)结合快速步行训练,FES刺激患侧腓总神经和胫前肌;对照组采用常规的减重跑台快速步行训练。分别在治疗前、治疗后评定6分钟步行距离(6MWD)及生理耗能指数(PCI)。结果:治疗4周后,2组PCI较治疗前有显著降低(P0.05),6MWD均较治疗前显著增加(P0.05);静息心率治疗前后比较差值无统计学意义。2组治疗后,观察组的PCI明显低于对照组(P0.05),而6MWD、静息心率组间差异无统计学意义。结论:功能性电刺激结合快速步行训练和传统的减重跑台快速步行训练都能够显著改善脑卒中偏瘫后遗症期患者的社区性步行能力及生理耗能;功能性电刺激结合快速步行训练降低生理耗能更明显。     

Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study

Purpose: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS).

Method: A total of 42?MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3–5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions.

Results: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p?p?p?>?0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly.

Conclusion: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation.

• Implications for rehabilitation

• Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease.

• Different exercise modalities are commonly employed to control ataxic symptoms in MS patients.

• Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.

     

高强度间歇跑台训练对脑卒中慢性期偏瘫患者步行能力的影响

目的:探讨高强度间歇跑台训练对脑卒中慢性期偏瘫患者步行能力的有效性和安全性。方法:将脑卒中慢性期患者50例随机分为观察组25例(采用高强度间歇跑台进行训练)和对照组25例(采用传统康复治疗技术训练),比较2组患者训练前和训练后2周的功能性步行分级量表(FAC)、Berg平衡量表(BBS)、10m步行测试(10MWT)、6min步行测试(6MWT)、简式Fugl-Meyer功能量表下肢部分(FMA-LE)。结果:训练2周后,2组患者组内比较观察组FAC、BBS、10MWT、6MWT评分较治疗前有明显提高(P<0.05),且观察组上述评分明显高于对照组(P<0.05),治疗后2组患者FMA-LE评分比较差异无统计学意义。除训练后观察组患者治疗期间出现2例大腿酸痛外,其余无不良反应。结论:高强度间歇跑台训练可以在较短时间内改善脑卒中慢性期偏瘫患者的步行能力且训练过程安全无严重不良反应。     

Effect of training on the post-exercise ankle blood pressure reaction in patients with intermittent claudication

Summary. The effect of physical training on the post-exercise blood pressure reaction in the ankle was studied in 63 patients with intermittent claudication but without angina pectoris. After three months of supervised training the maximal walking distance increased by 67% and the pain-free walking distance by 73%. Compared with that after the pre-training treadmill test, the ankle blood pressure was significantly higher 2–16 min after the post-training test and more rapidly returned to the initial resting value, both with similar work loads and with a higher post-training work load. Blood pressure measurement in the ankle after exercise is useful as an objective test of the circulatory effect of training in patients with intermittent claudication.     

Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial

Purpose: Treadmill training with body weight support (TTBWS) for relearning walking ability after brain damage is an approach under current investigation. Efficiency of this method beyond traditional training is lacking evidence, especially in patients needing walking assistance after stroke. The objective of this study was to investigate change in walking and transfer abilities, comparing TTBWS with traditional walking training. Methods: A single-blinded, randomized controlled trial was conducted. Sixty patients referred for multi-disciplinary primary rehabilitation were assigned into one of two intervention groups, one received 30 sessions of TTBWS plus traditional training, the other traditional training alone. Daily training was 1?hr. Outcome measures were Functional Ambulation Categories (FAC), Walking, Functional Independence Measure (FIM); shorter transfer and stairs, 10 m and 6-min walk tests. Results: Substantial improvements in walking and transfer were shown within both groups after 5 and 11 weeks of intervention. Overall no statistical significant differences were found between the groups, but 12 of 17 physical measures tended to show improvements in favour of the treadmill approach. Conclusions: Both training strategies provided significant improvements in the tested activities, suggesting that similar outcomes can be obtained in the two modalities by systematic, intensive and goal directed training.

Implications for Rehabilitation

• Treadmill training with body weight support (TTBWS) and traditional gait training were found to be equally effective in improving walking and transfer in patients dependent on walking assistance after stroke.

• However, most outcome measures showed a tendency of improvement in favour of the treadmill group.

• Both training modalities were systematic, goal-directed and intensive, and the time used for training was the same.

• The choice between the two equally effective training alternatives should be based on the patients’ preference, and availability of equipment and resources.

     

Effects of Vacusac in intermittent claudication: a controlled cross-over study

Summary. The effect of a new physical treatment modality, Vacusac, was tested on a group of patients with stable intermittent claudication. Twenty-two patients with a median age of 65 years and a median duration of intermittent claudication of 5 years were randomized to either active or placebo treatments. Seventeen patients completed the study. The effect of treatment was quantified by measurements of systemic -and peripheral systolic blood pressures and by measurements of the pain-free and the maximal walking distance on a treadmill. The ankle pressure index (ankle systolic pressure/arm systolic pressure) and toe pressure index (toe systolic pressure/arm systolic pressure) were calculated. After 25 active treatments, administered over a period of 2 months, the patients allocated to this group attained a significant increase in the pain-free walking distance from 54 m (24–107 m) to 99 m (30–420 m) (P < 0·05) and in the maximal walking distance from 99 m (36–182 m) to 185 m (68–591 m) (P < 0·05). The patient group receiving 25 placebo treatments did not show any significant changes in either the pain-free or the maximal walking distance. This group then received 25 active treatments over a period of 2 months. This active treatment resulted in a significant increase in the pain-free walking distance from 51 m (14–100 m) to 86 m (18–1000 m) (P < 0·05) and in the maximal walking distance from 98 m (40–199 m) to 175 m (51–1000 m) (P < 0·05). Ten out of the 17 patients who completed the study achieved a doubling of their maximal walking distance. The patients randomized to active treatment attained a significant increase in the ankle pressure index from 0–46 (0–39-0·67) to 0·58 (0·46-0·94) (P < 0·05) while the toe pressure index was unchanged. The patients randomized to placebo treatment did not show any significant changes in these ratios, either during the period of placebo treatment, or during the period of active treatment. In conclusion, our study has shown that physical treatment with the Vacusac equipment significantly increases the walking distance in patients with stable, intermittent claudication of long duration.     

Validity of the shuttle walk test as a functional assessment of walking ability in individuals with polyneuropathy

Purpose: This study assessed the validity of the shuttle walk test (SWT) to evaluate walking ability in patients with polyneuropathy.

Methods: Forty-one patients with chronic idiopathic axonal polyneuropathy (CIAP) and 49 patients with multifocal motor neuropathy (MMN) performed both the 10-meter walk test (10MWT) and the SWT. Face validity was assessed by evaluating whether patients considered both tests to reflect their walking ability (Likert scale: 1?=?not at all, 10?=?very well). Concurrent validity was determined by Spearman rank-correlation analyses performed on the outcomes of both tests.

Results: Mean (SD) scores for how well the 10MWT and SWT reflected daily walking ability were 6.8 (1.3) and 7.4 (1.6) (p?=?0.117) in patients with CIAP and 6.9 (1.2) and 7.9 (1.0) (p?=?0.001) in patients with MMN, respectively. Correlation scores between both tests ranged from ?0.70 to ?0.82, except for 18 patients with MMN with a “normal” walking speed at the 10MWT (?0.21).

Conclusion: The SWT seems a valid instrument for assessing walking ability in individuals with CIAP and MMN. Moreover, the SWT seems to be useful for investigating the symptoms elicited by walking long distances and may be more sensitive to changes when compared to the 10MWT.

• Implications for Rehabilitation

• Patients with polyneuropathy mainly experience problems when walking long distances.

• The 10-meter walk test does not possess sufficient psychometrics to diagnose walking abilities in these circumstances.

• The shuttle walk test is a valid instrument for assessing walking ability in individuals with polyneuropathy and might be the preferred instrument of choice when compared to the 10-meter walk test.

     

Training to walk amid uncertainty with Re-Step: measurements and changes with perturbation training for hemiparesis and cerebral palsy

Abstract

Purpose: To describe Re-Step?, a novel mechatronic shoe system that measures center of pressure (COP) gait parameters and complexity of COP dispersion while walking, and to demonstrate these measurements in healthy controls and individuals with hemiparesis and cerebral palsy (CP) before and after perturbation training. Method: The Re-Step? was used to induce programmed chaotic perturbations to the feet while walking for 30?min for 36 sessions over 12-weeks of training in two subjects with hemiparesis and two with CP. Results: Baseline measurements of complexity indices (fractal dimension and approximate entropy) tended to be higher in controls than in those with disabilities, while COP variability, mean and variability of step time and COP dispersion were lower. After training the disabled subjects these measurement values tended toward those of the controls, along with a decrease in step time, 10?m walk time, average step time, percentage of double support and increased Berg balance score. Conclusions: This pilot trial reveals the feasibility and applicability of this unique measurement and perturbation system for evaluating functional disabilities and changes with interventions to improve walking.

• Implication for Rehabilitation

• Walking, of individuals with cerebral palsy and hemiparesis following stroke, can be viewed in terms of a rigid motor behavior that prevents adaptation to changing environmental conditions.

• Re-Step system (a) measures and records linear and non-linear gait parameters during free walking to provide a detailed evaluation of walking disabilities, (b) is an intervention training modality that applies unexpected perturbations during walking.

• This perturbation intervention may improve gait and motor functions of individuals with hemiparesis and cerebral plasy.