Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators

Su P-F, Gard SA, Lipschutz RD, Kuiken TA. Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators.

Objectives

To examine differences in gait characteristics between persons with bilateral transtibial amputations because of trauma and peripheral vascular disease (PVD); and to compare that with data from able-bodied controls that were previously collected and maintained in a laboratory database.

Design

Observational study of persons with bilateral transtibial amputations.

Setting

A motion analysis laboratory.

Participants

Nineteen bilateral transtibial amputees.

Intervention

No experimental intervention was performed. To standardize the effect of prosthetic foot type, subjects were fitted with Seattle Lightfoot II feet 2 weeks before quantitative gait analyses.

Main Outcome Measures

Temporospatial, kinematic, and kinetic gait data were recorded and analyzed.

Results

Results showed that the freely selected walking speeds of subjects with PVD and trauma were 0.69m/s and 1.11m/s, respectively, while that of able-bodied control subjects was 1.20m/s. When data were compared on the basis of freely selected walking speed, numerous differences were found in temporospatial, kinematic, and kinetic parameters between the PVD and trauma groups. However, when data from similar speeds were compared, the temporospatial, kinematic, and kinetic gait data demonstrated no statistically significant differences between the 2 amputee groups. Although not statistically significant, the PVD group displayed increased knee (P=.09) and hip (P=.06) flexion during the swing phase, whereas the trauma group displayed increased pelvic obliquity (P=.06). These actions were believed to represent different strategies to increase swing phase foot clearance. Also, the PVD group exhibited slightly greater hip power (P=.05) before toe-off.

Conclusions

Many of the differences observed in the quantitative gait data between the trauma and PVD groups appeared to be directly associated with their freely selected walking speed; the trauma group walked at significantly faster freely selected speeds than the PVD group. When their walking speeds were matched, both amputee groups displayed similar gait characteristics, with the exception that they might use slightly different strategies to increase foot clearance.     

The effects of hip and ankle stretching on gait function of older people

Christiansen CL. The effects of hip and ankle stretching on gait function of older people.

Objective

To examine effects of hip and ankle stretching on gait function of older people.

Design

Randomized controlled trial.

Setting

Flexibility training was performed in participants' homes. Assessments were performed in a biomechanics laboratory.

Participants

Forty healthy volunteers (mean age ± SD, 72.1±4.7y) randomized to 2 groups: intervention (n=20) and control (n=20).

Intervention

Intervention participants performed an 8-week stretching program, and control group participants maintained activity level for 8 weeks. One investigator made weekly visits to instruct and monitor participants.

Main Outcome Measures

Primary outcome measures were passive joint motion for hip extension and ankle dorsiflexion and freely chosen gait speed. Secondary outcome measures were gait parameters during freely chosen gait speed and set gait speed walking (stride length, joint displacement).

Results

Compared with the control group, the intervention group had increased combined hip and knee motion (P=.023), ankle motion (P=.020), and freely chosen gait speed (P=.016). The intervention group showed statistically nonsignificant trends of increased stride length at freely chosen gait speed and set gait speed.

Conclusions

Findings suggest joint motion is a modifiable impairment that is effectively targeted with flexibility training for older people. Participants in the intervention group had improvements in joint motion as well as increased freely chosen gait speed. Mechanisms responsible for changes in freely chosen gait speed warrant further investigation.     

Three-dimensional motions of trunk and pelvis during transfemoral amputee gait

Goujon-Pillet H, Sapin E, Fodé P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait.

Objectives

To identify characteristics of upper-body kinematics and torque transmission to the ground during locomotion in a group of patients with transfemoral amputation as compared with a group of asymptomatic subjects; and to investigate the influence of walking velocity and residual limb length on several characteristics of upper-body motion.

Design

Three-dimensional gait analysis with an optoelectronic device.

Setting

Gait laboratory.

Participants

Twenty-seven patients with transfemoral amputation and a control group of 33 nondisabled subjects.

Interventions

Not applicable.

Main Outcome Measures

Three-dimensional kinematics of the pelvis and the thorax and ground reaction force for amputees and control subjects.

Results

For subjects with transfemoral amputation, it was observed that upper-body angular ranges of motion (ROMs) increased globally as walking velocity decreased. For these subjects, specific patterns of pelvic rotation and torque transmission by the lower limbs around the vertical axis were found. The counter-rotation between the pelvic and scapular girdles was reduced. This reduction proved to be linked with the decrease of walking velocity. Walking velocity also affected all the parameters describing the motion of upper body. Pelvic ROM increased with the length of the limb decreasing.

Conclusions

The huge differences found between subjects with and without amputation suggest that the motion of the upper body must be considered to enhance gait.     

Gait Analysis in Patients With Parkinson's Disease Off Dopaminergic Therapy

Švehlík M, Zwick EB, Steinwender G, Linhart WE, Schwingenschuh P, Katschnig P, Ott E, Enzinger C. Gait analysis in patients with Parkinson's disease off dopaminergic therapy.

Objective

To compare time-distance, kinematic, and kinetic gait parameters in patients with idiopathic Parkinson's disease (PD) off dopaminergic therapy with a group of healthy control subjects.

Design

A group-comparison study.

Setting

Gait analysis laboratory.

Participants

Patients with PD (n=20) and healthy age-matched controls (n=20).

Interventions

Not applicable.

Main Outcome Measures

Time-distance, kinematic, and kinetic gait variables.

Results

PD patients walked slower with shorter stride-length, comparable cadence, and longer double support times. Kinematics showed a reduction of the range of motion in the hip, knee, and ankle joints. Maximum hip extension and the ankle plantar flexion were significantly reduced. Kinetic gait parameters showed reduced push-off ankle power and lift-off hip power generation. Strong correlations between these important body advancement mechanisms and the walking velocity were observed.

Conclusions

In addition to previously described dysfunctional kinematics, abnormal kinetic parameters play an important role in the characterization of gait in PD patients off therapy. Hence, these parameters could be used to document treatment effects of parkinsonian gait disorders.     

Effects of Weight-Bearing Versus Nonweight-Bearing Exercise on Function, Walking Speed, and Position Sense in Participants With Knee Osteoarthritis: A Randomized Controlled Trial

Jan M-H, Lin C-H, Lin Y-F, Lin J-J, Lin D-H. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial.

Objective

To investigate whether weight-bearing (WB) exercise enhances functional capacity to a greater extent than nonweight-bearing (NWB) exercise in participants with knee osteoarthritis.

Design

Randomized controlled trial.

Setting

Kinesiology laboratory.

Participants

Participants (N=106) were randomly assigned to WB exercise, NWB exercise, or a control group (no exercise).

Intervention

WB exercise and NWB exercise groups underwent an 8-week knee extension-flexion exercise program.

Main Outcome Measures

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale, walking speed, muscle torque, and knee reposition error were assessed before and after intervention.

Results

Equally significant improvements were apparent for all outcomes after WB exercise and NWB exercise, except for reposition error, for which improvement was greater in the WB exercise group. In contrast, there were no improvements in the control group.

Conclusions

Simple knee flexion and extension exercises (WB and NWB) performed over 8 weeks resulted in significant improvement in the WOMAC function scale and knee strength compared with the control group. NWB exercise alone may be sufficient enough to improve function and muscle strength. The additional benefit of WB exercise was improved position sense, which may enhance complex walking tasks (walking on figure of 8 route and spongy surface).     

A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis

Andrysek J, Redekop S, Matsui NC, Kooy J, Hubbard S. A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis.

Objectives

To determine (1) the forces and moments passing through knee-ankle-foot orthoses (KAFOs) during walking and (2) the accuracy with which these loads can be measured using conventional gait analysis techniques.

Design

Comparative case series.

Setting

Rehabilitation facility with human movement laboratory (gait lab).

Participants

Four patients with poliomyelitis wearing KAFOs.

Interventions

KAFOs were instrumented with a load cell, and walking data were concurrently collected using conventional gait analysis.

Main Outcome Measures

Load measurements and gait parameters.

Results

Predominant orthotic loads (knee joint forces and moments) were composed of knee flexion moments and axial compression forces. With conventional gait analysis, peak knee joint moments were substantially underestimated compared with those directly measured using the load cell. Defining the knee axis anatomically versus at the orthotic axis, tracking it dynamically, and compensating for each patient's corrected knee flexion contracture resulted in considerable improvements in the gait lab estimates of knee joint moments.

Conclusions

A practical method that directly measures moments and forces in conventional KAFOs has been applied to show that conventional gait analysis techniques substantially underestimate knee joint moments in the KAFOs of persons with poliomyelitis. Underestimation of orthotic loads could result in underdesigned orthotic components and ultimately higher incidence of component failure in clinical applications.     

Test-retest reliability and minimal clinical change determination for 3-dimensional tibial and femoral accelerations during treadmill walking in knee osteoarthritis patients

Turcot K, Aissaoui R, Boivin K, Hagemeister N, Pelletier M, de Guise JA. Test-retest reliability and minimal clinical change determination for 3-dimensional tibial and femoral accelerations during treadmill walking in knee osteoarthritis patients.

Objective

To determine the test-retest reliability and the minimal clinical change determination for accelerometric parameters, estimated by a new accelerometric-based method that estimates 3-dimensional (3D) linear accelerations of the tibia and femur during comfortable and fast walking speeds.

Design

Test-retest study.

Setting

Gait laboratory in a research center.

Participants

Patients (N=25; 6 men, 19 women) with symptomatic knee osteoarthritis (OA).

Interventions

Not applicable.

Main Outcomes Measures

Subjects attended 2 walking sessions in which accelerometers were rigidly fixed by means of an exoskeleton to the femoral and tibial segments. In both sessions, 3D accelerations were collected for 25 seconds for each of the walking speeds. Mean accelerometric pattern was calculated using 15 gait cycles. From each mean pattern, maximal, minimal, and range values were extracted from the loading phase period. The root mean square (RMS) value was also calculated for every pattern. Relative and absolute reliability were determined using intraclass correlation (ICC) and standard error (SE) of measurement, respectively. Minimal detectable change was calculated for each parameter as the least significant difference.

Results

Tibial and femoral accelerations showed reliable values across sessions 1 and 2 with ICCs greater than or equal to .75 for 96% and 88% of the parameters at comfortable and fast speeds, respectively. The SE of measurement ranged from .01 to .05g for the RMS value and from .05 to .35g for maximal, minimum, and range point parameters.

Conclusions

The proposed method is the first to have determined the reliability and the minimal detectable change for tibial and femoral acceleration parameters in knee OA patients during a treadmill walking evaluation. The minimal detectable change determined in this study will be used to determine improvement or deterioration of knee OA patients after rehabilitation.     

Incidence of Gait Abnormalities After Traumatic Brain Injury

Williams G, Morris ME, Schache A, McCrory PR. Incidence of gait abnormalities after traumatic brain injury.

Objective

To identify the most common gait abnormalities presenting after traumatic brain injury (TBI) and quantify their incidence rate.

Design

Case series.

Setting

Biomechanics laboratory.

Participants

A convenience sample of 41 people with TBI receiving therapy for gait abnormalities, and a sample of 25 healthy controls.

Intervention

Three-dimensional gait analysis.

Main Outcome Measures

Spatiotemporal, kinematic, and kinetic data at a self-selected walking speed.

Results

People with TBI walked with a significantly slower speed than matched healthy controls. There was a significant difference between groups for cadence, step length, stance time on the affected leg, double support phase, and width of base of support. The most frequently observed biomechanical abnormality was excessive knee flexion at initial foot contact. Other significant gait abnormalities were increased trunk anterior/posterior amplitude of movement, increased anterior pelvic tilt, increased peak pelvic obliquity, reduced peak knee flexion at toe-off, and increased lateral center of mass displacement. Ankle equinovarus at foot-contact occurred infrequently.

Conclusions

People with TBI were found to have multijoint gait abnormalities. Many of these abnormalities have not been previously reported in this population.     

Selective Tibial Neurotomy in the Treatment of Spastic Equinovarus Foot in Hemiplegic Patients: A 2-Year Longitudinal Follow-Up of 30 Cases

Deltombe T, Gustin T. Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases.

Objective

To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients.

Design

Intervention study (before-after trial) with an observational design and 2-year follow-up.

Setting

Spasticity group in a university hospital.

Participants

Hemiplegic patients (N=30) with spastic equinovarus foot.

Intervention

A selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve.

Main Outcome Measures

Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6 min walking test), and gait kinematics (video assessment) were assessed before and at 2 months, 1 year, and 2 years after selective tibial neurotomy.

Results

Compared with preoperative values, there was a statistically significant decrease in triceps surae spasticity, an increase in gait speed, and a reduction in equinus and varus in swing and stance phases at 2 months postoperatively. This improvement persisted at 1 and 2 years after selective tibial neurotomy. Selective tibial neurotomy does not induce permanent triceps muscle weakness or triceps surae-Achilles' tendon complex shortening.

Conclusion

This study confirms the long-lasting beneficial effect of selective tibial neurotomy on spasticity, gait speed, and equinovarus deformity in the treatment of spastic equinovarus foot in hemiplegic patients.     

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.     

Bed exercises following total hip replacement: a randomised controlled trial

Objectives

To determine whether the addition of bed exercises after primary total hip replacement (THR) improves functional outcomes and quality of life, in adult patients, during the first six postoperative weeks.

Design

Single-blind randomised controlled trial.

Setting

Inpatient and outpatient orthopaedic departments at a National Health Service hospital.

Participants

Sixty primary elective THR patients.

Intervention

Patients were assigned at random to receive either a standard gait re-education programme and bed exercises, or the standard gait re-education programme without bed exercises after THR. The bed exercises consisted of active ankle dorsiflexion/plantarflexion, active knee flexion, and static quadriceps and gluteal exercises.

Main outcome measures

Iowa Level of Assistance Scale (ILOA), the Short Form-12 Health Survey (SF-12), duration of hospital admission and postoperative complications were assessed at baseline, and 3 days and 6 weeks postoperatively.

Results

There was no statistically significant difference in ILOA scores between the two groups on the third postoperative day [gait re-education and bed exercise group median 40.5, interquartile range (IQR) 17.5 to 44.5; gait re-education alone group median 38, IQR 22.0 to 44.5; P = 0.70]. Although there was a small difference between the median ILOA scores at Week 6 between the two groups (3.5, IQR 0 to 6.4 and 5.0, IQR 3.5 to 12.5; P = 0.05), this difference was not statistically or clinically significant. There was no difference between the groups in duration of hospital admission, SF-12 scores or postoperative complications at Week 6.

Conclusion

This study suggests that during the first six postoperative weeks, the addition of bed exercises to a standard gait re-education programme following THR does not significantly improve patient function or quality of life.     

Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial

Yang YR, Wang RY, Chen YC, Kao MJ. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial.

Objective

To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke.

Design

Single-blind randomized controlled trial.

Setting

General community.

Participants

Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects (a minimum gait velocity, 58cm/s).

Interventions

Participants were randomized into a control group (n=12) or experimental group (n=13). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group underwent a 4-week ball exercise program.

Main Outcome Measures

Gait performance was measured under single task (preferred walking) and tray-carrying task. Gait parameters of interest were walking speed, cadence, stride time, stride length, and temporal symmetry index.

Results

The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions. In the control group, there were no significant changes over the 4-week period for all selected measures. There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions.

Conclusions

The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke.     

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.     

Detection of Gait and Postures Using a Miniaturized Triaxial Accelerometer-Based System: Accuracy in Patients With Mild to Moderate Parkinson's Disease

Dijkstra B, Kamsma YP, Zijlstra W. Detection of gait and postures using a miniaturized triaxial accelerometer-based system: accuracy in patients with mild to moderate Parkinson's disease.

Objective

To examine whether gait and postures can accurately be detected with a single small body-fixed device in patients with mild to moderate Parkinson's disease (PD).

Design

Results of a triaxial accelerometer-based method were evaluated against video observation scores (criterion measure). Study 1: Subjects performed basic mobility-related activities (walking, lying, sitting, standing) in a fixed and free sequence. Study 2: Subjects were monitored while doing similar activities as in study 1 and while doing usual domestic activities.

Setting

Study 1: Standardized set-up in a movement laboratory. Study 2: Home environment.

Participants

(N=37) Study 1: Patients with PD (n=32; mean age ± SD, 67.3±6.6y; mean disease duration ± SD, 6.1±3.4y). Study 2: Patients with PD (n=5; mean age ± SD, 76.0±7.3y; mean disease duration ± SD, 3.8±4.7y).

Interventions

Not applicable.

Main Outcome Measures

The degree of correspondence between the monitor and the video observation for the duration of each activity. Overall agreement, sensitivity, specificity, and positive predictive values were calculated.

Results

Study 1: Overall agreement ranged between 69.8% and 90.8% (fixed sequence) and 57.5% and 96.9% (free sequence). Study 2: Overall agreement ranged between 60.0% and 89.2%. Lying, sitting (home), and walking were detected most accurately with mean sensitivity varying from 81.7% to 99.9%. Lower values were found for sitting (laboratory), standing, and shuffling.

Conclusions

This triaxial monitor system is a practical and valuable tool for objective, continuous evaluation of walking and postures in patients with mild to moderate PD. Detection of sitting and standing requires further fine-tuning.     

Objective monitoring of adherence with home exercise training during pulmonary rehabilitation for chronic obstructive pulmonary disease

Objectives

Outpatient pulmonary rehabilitation relies on the patient completing bouts of unsupervised exercise at home. The aim of this study was to monitor adherence with a home walking programme using activity monitors.

Design

The sensitivity and reliability of five activity monitors were initially established at speeds at which patients are advised to walk. Thereafter, 18 patients with established chronic obstructive pulmonary disease attending pulmonary rehabilitation were recruited. All patients were required to wear a small device around their waist for two, 7-day periods during the 7-week course of rehabilitation. During this time, patients also completed a home diary card. Adherence was monitored by frequency, duration and intensity of walks.

Setting

Pulmonary Rehabilitation Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.

Results

The activity monitors were able to clearly discriminate varying walking speeds and were reproducible at each pre-selected speed (P < 0.05). However, between-monitor comparison was not reproducible at the pre-determined speeds. Individually prescribed walking speeds for home training ranged from 1.76 to 4.83 km/hour. As a group, only two patients failed to achieve 100% of total adherence. Adherence for the individual components varied widely.

Conclusion

Activity monitor technology appears to be able to discriminate individually prescribed walking speeds that allow home walking programmes to be monitored.     

Effects of Aquatic Resistance Training on Mobility Limitation and Lower-Limb Impairments After Knee Replacement

Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement.

Objective

To study the effects of aquatic resistance training on mobility, muscle power, and cross-sectional area.

Design

Randomized controlled trial.

Setting

Research laboratory and hospital rehabilitation pool.

Participants

Population-based sample (N=50) of eligible women and men 55 to 75 years old 4 to 18 months after unilateral knee replacement with no contraindications who were willing to participate in the trial.

Interventions

Twelve-week progressive aquatic resistance training (n=26) or no intervention (n=24).

Main Outcome Measures

Mobility limitation assessed by walking speed and stair ascending time, and self-reported physical functional difficulty, pain, and stiffness assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee extensor power and knee flexor power assessed isokinetically, and thigh muscle cross-sectional area (CSA) by computed tomography.

Results

Compared with the change in the control group, habitual walking speed increased by 9% (P=.005) and stair ascending time decreased by 15% (P=.006) in the aquatic training group. There was no significant difference between the groups in the WOMAC scores. The training increased knee extensor power by 32% (P<.001) in the operated and 10% (P=.001) in the nonoperated leg, and knee flexor power by 48% (P=.003) in the operated and 8% (P=.002) in the nonoperated leg compared with controls. The mean increase in thigh muscle CSA of the operated leg was 3% (P=.018) and that of the nonoperated leg 2% (P=.019) after training compared with controls.

Conclusions

Progressive aquatic resistance training had favorable effects on mobility limitation by increasing walking speed and decreasing stair ascending time. In addition, training increased lower limb muscle power and muscle CSA. Resistance training in water is a feasible mode of rehabilitation that has wide-ranging positive effects on patients after knee replacement surgery.     

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.     

Functional Assessment of Lower Extremities in Hereditary Spastic Paraplegia

Braschinsky M, Parts K, Maamägi H, Gross-Paju K, Haldre S. Functional assessment of lower extremities in hereditary spastic paraplegia.

Objectives

To characterize the spasticity and range of motion (ROM) in patients with hereditary spastic paraplegia (HSP) and to correlate these parameters with walking speed.

Design

An observational population-based cohort study.

Setting

Patient data were acquired from a population-based epidemiologic study performed earlier in Estonia.

Participants

Persons (N=46) (mean age, 50.1y) with clinically confirmed HSP diagnosis (mean duration, 20.9y) participated in the study.

Interventions

Active and passive ROMs were measured with a plastic 360° goniometer. Spasticity was evaluated by using the modified Ashworth scale (MAS). The time it took a patient to walk 10m was recorded.

Main Outcome Measures

Measurements included testing of active and passive ROM as a marker for mobility, the MAS for spasticity, and time to complete a 10-m walk.

Results

A higher degree of spasticity in hip muscles was associated with lower values of active ROM and slower walking. Walking speed was negatively correlated to disease duration and participant age.

Conclusions

The present study provides analysis of the contributions of spasticity and ROM to walking speed in HSP, both factors negatively influence gait in persons with HSP.