Examination of Sustained Gait Speed During Extended Walking in Individuals With Chronic Stroke

Objectives

To determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups.

Design

Prospective cross-sectional study.

Setting

University-based research laboratory, hospitals, and stroke support groups.

Participants

A sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit.

Interventions

Not applicable; 1-time cross-sectional data collection.

Main Outcome Measures

During the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups.

Results

During the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences.

Conclusions

Predicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed.     

Health-Related Physical Fitness Measures: Reference Values and Reference Equations for Use in Clinical Practice

Objective

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice.

Design

Cross-sectional design.

Setting

General community.

Participants

Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway.

Interventions

Not applicable.

Main Outcome Measures

The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test).

Results

The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age.

Conclusions

The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.     

Assessing Locomotion Ability in West African Stroke Patients: Validation of ABILOCO-Benin Scale

Objective

To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients.

Design

Prospective study and questionnaire development.

Setting

Rehabilitation centers.

Participants

Stroke patients (N=230; mean age ± SD, 51.1±11.6y; 64.3% men).

Intervention

Not applicable.

Main Outcome Measures

Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as “impossible,” “difficult,” or “easy.” The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale.

Results

Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001).

Conclusions

ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients.     

Effects of an Anterior Ankle-Foot Orthosis on Walking Mobility in Stroke Patients: Get Up and Go and Stair Walking

Objective

To examine the effects of an anterior ankle-foot orthosis (AAFO) on walking mobility in stroke patients.

Design

Cross-sectional and repeated-measures study design.

Setting

A university's neurologic rehabilitation department.

Participants

Ambulant stroke patients (N=21).

Interventions

Not applicable.

Main Outcome Measures

Walking mobility was measured by the Timed Up and Go (TUG) test and the Timed Up and Down Stairs (TUDS) test. The paired t test was used to determine the difference between the mobility performances measured with and without the AAFO.

Results

There were significant differences between mobility performances with and without an AAFO in the TUG test (P=.038) and the TUDS test (P=.000).

Conclusions

This study supports the effect of an AAFO on walking mobility in stroke patients. The findings demonstrate that stroke patients wearing an AAFO may ambulate with greater speed and safety on level surfaces and stairs.     

Clinical Application of a Robotic Ankle Training Program for Cerebral Palsy Compared to the Research Laboratory Application: Does It Translate to Practice?

Objective

To determine the clinical efficacy of an ankle robotic rehabilitation protocol for patients with cerebral palsy.

Design

The clinic cohort was identified from a retrospective chart review in a before-after intervention trial design and compared with a previously published prospective research cohort.

Setting

Rehabilitation hospital.

Participants

Children (N=28; mean age, 8.2±3.62y) with Gross Motor Function Classification System levels I, II, or III who were referred for ankle stretching and strengthening used a robotic ankle device in a clinic setting. Clinic results were compared with a previously published cohort of participants (N=12; mean age, 7.8±2.91y) seen in a research laboratory-based intervention protocol.

Interventions

Patients in the clinic cohort were seen 2 times per week for 75-minute sessions for a total of 6 weeks. The first 30 minutes of the session were spent using the robotic ankle device for ankle stretching and strengthening, and the remaining 45 minutes were spent on functional movement activities. There was no control group.

Main Outcome Measures

We compared pre- and postintervention measures of plantarflexor and dorsiflexor range of motion, strength, spasticity, mobility (Timed Up and Go test, 6-minute walk test, 10-m walk test), balance (Pediatric Balance Scale), Selective Control Assessment of the Lower Extremity (SCALE), and gross motor function measure (GMFM).

Results

Significant improvements were found for the clinic cohort in all main outcome measures except for the GMFM. These improvements were equivalent to those reported in the research cohort, except for larger SCALE test changes in the research cohort.

Conclusions

These findings suggest that translation of repetitive, goal-directed biofeedback training into the clinic setting is both feasible and beneficial for patients with cerebral palsy.     

Feasibility,safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study

Objectives

To assess the feasibility, safety and outcomes of playing Microsoft Kinect Adventures™ for people with Parkinson's disease in order to guide the design of a randomised clinical trial.

Design

Single-group, blinded trial.

Setting

Rehabilitation Center of São Camilo University, Brazil.

Participants

Seven patients (six males, one female) with Parkinson's disease (Hoehn and Yahr Stages 2 and 3).

Interventions

Fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures!

Main outcome measures

The feasibility and safety outcomes were patients’ game performance and adverse events, respectively. The clinical outcomes were the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and Parkinson's Disease Questionnaire (PDQ-39).

Results

Patients’ scores for the four games showed improvement. The mean [standard deviation (SD)] scores in the first and last sessions of the Space Pop game were 151 (36) and 198 (29), respectively [mean (SD) difference 47 (7), 95% confidence interval 15 to 79]. There were no adverse events. Improvements were also seen in the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and PDQ-39 following training.

Conclusion

Kinect-based training was safe and feasible for people with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Patients improved their scores for all four games. No serious adverse events occurred during training with Kinect Adventures!, which promoted improvement in activities (balance and gait), body functions (cardiopulmonary aptitude) and participation (quality of life).     

Deep Repetitive Transcranial Magnetic Stimulation With H-coil on Lower Limb Motor Function in Chronic Stroke: A Pilot Study

Objectives

To assess the efficacy of high-frequency (20Hz) brain stimulation on lower limb motor function in subjects with chronic (>6mo) subcortical stroke.

Design

Double-blind, placebo-controlled crossover study.

Setting

University hospital.

Participants

Right-handed subjects (N=10) affected by a first-ever subcortical stroke in the territory of the middle cerebral artery were included in this study.

Interventions

Repetitive transcranial magnetic stimulation (rTMS) was delivered with the H-coil, specifically designed to target deeper and larger brains regions. Each subject received both real and sham rTMS in a random sequence. The 2 rTMS cycles (real or sham) were composed of 11 sessions each, administered over 3 weeks and separated by a 4-week washout period.

Main Outcome Measures

Lower limb functions were assessed by the lower limb Fugl-Meyer scale, the 10-m walk test, and the 6-minute walk test before and 1 day after the end of each treatment period, as well as at a 4-week follow-up.

Results

Real rTMS treatment was associated with a significant improvement in lower limb motor function. This effect persisted over time (follow-up) and was significantly greater than that observed with sham stimulation. A significant increase in walking speed was also found after real rTMS, but this effect did not reach statistical significance in comparison with the sham stimulation.

Conclusions

These data demonstrated that 3 weeks of high-frequency deep rTMS could induce long-term improvements in lower limb functions in the chronic poststroke period, lasting at least 1 month after the end of the treatment.     

Evaluating the need for two incremental shuttle walk tests during a maintenance exercise program in people with COPD

Objective

To determine if there was an increase in walk distance when two incremental shuttle walk tests (ISWTs) were performed at the commencement of a maintenance exercise program (0 month) and at three, six and 12-month assessments.

Design

A prospective, longitudinal, repeated measures study in COPD.

Setting

Single site, hospital outpatient physiotherapy department.

Participants

Forty-eight participants (22 males) with COPD participated in the study: [baseline characteristics: mean (SD): FEV₁ 59 (19) % predicted; age 65 (8) years; BMI 26 (6) (kg/m²)].

Intervention

Participants completed two ISWTs at zero, three, six and twelve months.

Outcomes

Incremental shuttle walk distance (ISWD).

Results

There was a significant increase in walk distance between two ISWTs at zero month (17 metres (95% CI: 7 to 26) and three months (18 metres (95% CI: 6 to 30), but not at six or 12 months.

Conclusion

The increase in walk distance when a second ISWT was performed at zero and three months indicates the need to perform two ISWTs when participants are naïve to the test and at the three-month reassessment during a 12-month maintenance exercise program.     

Locomotion Improvement Using a Hybrid Assistive Limb in Recovery Phase Stroke Patients: A Randomized Controlled Pilot Study

Objective

To compare the efficacy of gait training using a single-leg version of the Hybrid Assistive Limb (HAL) on the paretic side with conventional gait training in individuals with subacute stroke.

Design

Randomized open controlled pilot trial.

Setting

Hospitalized care.

Participants

Convenience sample of 44 patients who met the criteria; 12 patients refused. After randomization (N=32), 10 patients withdrew and a total of 22 poststroke participants (HAL group: n=11; conventional group: n=11) completed the randomized controlled trial.

Interventions

All participants received twelve 20-minute sessions in 4 weeks of either HAL (wearing the single-leg version of the HAL on their paretic side) or conventional (performed by skilled and experienced physical therapists) gait training.

Main Outcome Measures

Outcome measures were evaluated prior to training and after 12 sessions. Functional Ambulation Category (FAC) was the primary outcome measure, whereas secondary outcome measures included maximum walking speed, timed Up and Go test, 6-minute walk distance, Short Physical Performance Battery, Fugl-Meyer Assessment of Lower Extremity, and isometric muscle strength (hip flexion and extension, knee flexion and extension).

Results

No participants withdrew because of adverse effects. Participants who received gait training with the HAL showed significantly more improvement in the FAC than those who received conventional gait training (95% confidence interval, .02–.88; P=.04). Secondary measures did not differ between the 2 groups.

Conclusions

The results obtained in this randomized controlled trial suggest that a gait training program with the HAL could improve independent walking more efficiently than conventional gait training.     

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.     

A Comparison of Robotic Walking Therapy and Conventional Walking Therapy in Individuals With Upper Versus Lower Motor Neuron Lesions: A Randomized Controlled Trial

Objective

To compare a walking reeducation program with robotic locomotor training plus overground therapy (LKOGT) to conventional overground training (OGT) in individuals with incomplete upper motor neuron (UMN) or lower motor neuron (LMN) injuries having either traumatic or nontraumatic nonprogressive etiology.

Design

Randomized open controlled trial with blind evaluation by an independent observer.

Setting

An inpatient spinal cord injury rehabilitation center.

Participants

A total of 88 adults within 6 months of spinal cord injury onset (group A, 44 with UMN injury, and group B, 44 with LMN injury) were graded on the American Spinal Injury Association Impairment Scale as C or D. Each of these groups was then randomly allocated to conditions 1 or 2.

Interventions

Condition 1: Subgroups A1 and B1 were treated with LKOGT for 60 minutes. Condition 2: Subgroups A2 and B2 received 60 minutes of conventional OGT 5 days per week for 8 weeks. Subjects with UMN and LMN were randomized into 2 training groups.

Main Outcome Measures

Ten-meter walk test and 6-minute walk test (6MWT). Walking Index for Spinal Cord Injury II, lower extremity motor score (LEMS), and the FIM-Locomotor were secondary outcome measures.

Results

By using the LKOGT program compared with OGT, we found significant differences in the 6MWT for groups A1 and B1. LKOGT also provided higher scores than did OGT in secondary outcomes such as the LEMS and the FIM-Locomotor.

Conclusions

Robotic-assisted step training yielded better results in the 6MWT and the LEMS in patients with UMN and LMN.     

Influence of Inspiratory Muscle Weakness on Inspiratory Muscle Training Responses in Chronic Heart Failure Patients: A Systematic Review and Meta-Analysis

Objective

To determine whether the impact of inspiratory muscle weakness on inspiratory muscle training (IMT) affects inspiratory function and exercise capacity in chronic heart failure (CHF) patients.

Data Sources

Electronic searches were performed using the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Cochrane Systematic Review, Embase, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases up to August 2013.

Study Selection

Articles were included if participants had CHF and were >18 years old; the design was a randomized controlled trial; intervention was IMT; measurements were of inspiratory muscle function or exercise capacity; and the articles were published in English, Portuguese, or Spanish. Of the 1455 articles identified in the database searches, 9 studies met the inclusion criteria.

Data Extraction

Two independent reviewers selected and extracted information from articles and assessed the quality of the studies using the PEDro scale. The 2 reviewers discussed disagreements until consensus was achieved.

Data Synthesis

Meta-analyses compared IMT with controls/sham for maximal inspiratory pressure, sustained maximal inspiratory pressure, 6-minute walk distance, peak oxygen consumption, and minute ventilation after IMT. Subgroup analyses compared those with and without muscle weakness. CHF with inspiratory muscle weakness showed greater gains in the 6-minute walk distance and peak oxygen consumption compared with those with normative maximal inspiratory pressure. The mean quality analysis score was 7.1, and scores ranged from 6 to 10.

Conclusions

The results emphasize the importance of evaluating the inspiratory muscles to identify patients with CHF and inspiratory muscle weakness; subgroup that showed better results after IMT.     

Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease

Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease.

Objective

To develop a predictive equation to permit estimation of the maximum work rate (Wmax) achieved during an incremental cycle ergometry test from the measurement of 6-minute walk distance (6MWD) and its derivative, 6-minute walk work, which is the product of 6MWD and body weight.

Design

Cross-sectional observational study.

Setting

Outpatient physiotherapy and pulmonary physiology clinics in a tertiary hospital.

Participants

Patients (N=50; 36 men) with chronic obstructive pulmonary disease (forced expiratory volume in 1 second [FEV₁]=37%±11% of predicted).

Interventions

Not applicable.

Main Outcome Measures

Measurements were obtained of 6MWD and Wmax achieved during a laboratory-based, symptom-limited incremental cycle ergometry test. Linear regression analyses were performed using 6MWD, height, weight, and FEV₁ and using 6-minute walk work, height, and FEV₁ to determine their contribution to Wmax and to develop predictive equations for estimating Wmax.

Results

The equations derived to estimate Wmax using 6MWD and 6-minute walk work, respectively, were as follows: Wmax (W)=(0.122×6MWD)+(72.683×height [m])-117.109 (r²=.67, standard error of the estimate [SEE]=10.8W) and Wmax (W)=17.393+(1.442×6-minute walk work) (r²=.60, SEE=11.8W).

Conclusions

Wmax can be estimated from equations based on measurements of 6MWD or 6-minute walk work. The estimate of Wmax derived from either equation may provide a basis on which to prescribe cycle ergometry training work rates that comply with the current guidelines for pulmonary rehabilitation.     

Multimodal Treatment of Distal Sensorimotor Polyneuropathy in Diabetic Patients: A Randomized Clinical Trial

Objective

The purpose of this study was to evaluate the effectiveness of the application of analyzing treadmill, muscle strengthening, and balance training compared with a standard care intervention in patients with diabetic neuropathy.

Methods

Twenty-seven patients, 63% female (mean ± standard deviations age, 72 ± 9 years), with diabetic neuropathy randomly assigned to receive a multimodal manual treatment approach including analyzing treadmill with feedback focused, isokinetic dynamometric muscle strengthening, and balance retraining on dynamic balance platform or a standard care intervention for activities targeted to improve endurance, manual exercises of muscle strengthening, stretching exercises, gait, and balance exercises (5 weekly over 4 weeks). This study was designed as a double-blind, randomized clinical trial. Measures were assessed at pretreatment, 4 weeks posttreatment, and 2-month follow-up.

Results

No important baseline differences were observed between groups. At the end of the treatment period, the experimental group showed a significant increase in gait endurance in a 6-minute walk test, 65.6 m (F_[2.0] = 9.636; P = .001). In addition, the 6-minute walk test increased after the intervention, and an even greater difference was found at follow-up (P = .005) for the standard care group. The Functional Independence Measure in both groups increased (P < .01) and continued until the follow-up in the standard care group (P = .003).

Conclusions

The results suggest that the experimental rehabilitation program showed positive effects on the gait endurance after 4 weeks of treatment, whereas it did not produce significant improvements of the gait speed. Both the treatments produced significant improvement of functionalities of the patient.     

Patients with musculoskeletal conditions do less vigorous physical activity and have poorer physical fitness than population controls: a cross-sectional study

Objectives

To compare physical activity and physical fitness in patients with various musculoskeletal conditions receiving physiotherapy in primary care with population controls.

Design

Cross-sectional.

Participants

One hundred and sixty-seven patients with musculoskeletal conditions receiving physiotherapy in primary care and 313 population controls from various settings and geographical areas.

Main outcome measures

Physical activity was measured with the International Physical Activity Questionnaire short-form (IPAQ-sf) and reported in metabolic equivalents (METs). The 6-minute walk test and 30-second sit-to-stand test reflected cardiorespiratory endurance and muscular strength, respectively.

Results

Differences in physical activity between the groups were explored using the Mann–Whitney U-test. The patient group reported significantly less vigorous activity compared with the control group {median 0 [interquartile range (IQR) 0 to 960] vs median 240 [IQR 0 to 1440] MET minutes/week, respectively)} (P = 0.001). A similar proportion of patients (68%) and controls (75%) reached the recommended level of health-enhancing physical activity (P = 0.11). Linear regression analyses adjusted for age, body mass index and gender showed significantly poorer fitness in the patient group compared with the control group, reflected by the 6-minute walk test and the 30-second sit-to-stand test {mean difference 69 m [95% confidence interval (CI) 52 to 85; P ≤ 0.001] and six repetitions [95% CI 5 to 7; P ≤ 0.001], respectively}.

Conclusions

Patients with various long-term musculoskeletal conditions receiving physiotherapy in primary care had significantly poorer physical fitness and reported less vigorous physical activity compared with population controls.     

Effects of Home-Based Locomotor Treadmill Training on Gross Motor Function in Young Children With Cerebral Palsy: A Quasi-Randomized Controlled Trial

Objective

To examine the effects of an intensive home-based program of treadmill training on motor skills related to walking in preambulatory children with cerebral palsy (CP).

Design

Quasi-randomized controlled trial.

Setting

Homes of the participants.

Participants

Children with CP (N=12) with Gross Motor Function Classification System levels I and II were assigned to the intervention group (n=6; mean age ± SD, 21.76±6.50mo) and control group (n=6; 21.25±6.07mo). All children were tested preintervention, postintervention, at a 1-month follow-up, and at a 4-month follow-up.

Interventions

All children received their weekly scheduled physical therapy sessions at their homes. In addition, children in the intervention group walked on a portable treadmill in their homes 6 times per week, twice daily for 10- to 20-minute sessions, for 6 weeks. The intervention was carried out by the children's parents with weekly supervision by a physical therapist.

Main Outcome Measures

Gross Motor Function Measure-66 Dimensions D/E, Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Inventory (PEDI), timed 10-m walk test (10MWT), and Functional Mobility Scale (FMS). The Friedman test and Mann-Whitney U test were conducted for within-group and between-group differences, respectively.

Results

There was a significant between-group treatment effect for the PDMS-2 at posttest (P=.01) and 1-month postintervention follow-up (P=.09), as well as for the PEDI at posttest (P=.01), the 1-month postintervention follow-up (P=.009), and the 4-month postintervention follow-up (P=.04). The FMS was significant at the posttest (P=.04).

Conclusions

Home-based treadmill training accelerates the attainment of walking skills and decreases the amount of support used for walking in young children with CP.     

Determinants of Use of a Walking Device in Persons With Parkinson's Disease

Objective

To identify determinants for the use of a walking device in persons with Parkinson's disease (PD).

Design

Cross-sectional study of participants with PD.

Setting

Laboratory.

Participants

Persons with PD (N=85; 60 men) were studied. Their mean age was 69.4±8.9 years. The average time since diagnosis was 7.9±5.3 years.

Interventions

Not applicable.

Main Outcome Measures

Age, sex, disease duration, disease severity, and motor impairment were recorded. Participants were asked whether they usually used any walking device (eg, cane or walker) and were categorized as either an “independent walker” or a “device walker.” Clinical balance measures including functional reach, turn duration, 5-meter timed Up and Go (5m-TUG) test, and Activities-specific Balance Confidence (ABC) scale were investigated for their contribution to the prediction of walking with a device.

Results

Thirty-one participants (36.5%) reported that they usually used a walking device. Classification and regression tree analysis determined that the 5m-TUG test and the ABC scale were important factors in differentiating participants who used a walking device from those who did not. Critical thresholds included 13 seconds for the 5m-TUG test and a score of 75 for the ABC scale in determining device walking. Using only these 2 determinants, the classification and regression tree model correctly classified 81% of the patients as either independent or needing a walking device.

Conclusion

The 5m-TUG test and the ABC scale may be useful in clinical assessments of the need for a walking device in persons with PD.     

Validity of the 6-minute walk test for assessing heart rate recovery after an exercise-based cardiac rehabilitation programme

Objectives

To compare heart rate responses in the 6-minute walk test and the treadmill exercise test before and after an exercise-based cardiac rehabilitation programme.

Design

Prospective cohort study.

Setting

Hospital-based cardiac rehabilitation programme in Hong Kong.

Participants

Thirty patients (mean age 62.1 ± 8.5 years, 20 males) with stable ischaemic heart disease.

Interventions

Eight-week exercise-based cardiac rehabilitation programme involving upper and lower limb aerobic and resistance training.

Main outcome measures

Six-minute walk test and treadmill exercise test before and after the exercise programme.

Results

Comparing parameters before and after the exercise programme, the peak heart rate in the 6-minute walk test increased (median of 105 beats per minute (bpm), interquartile range 96.8-116.5 versus 110 bpm, interquartile range 100.5-124.5, P = 0.006), while heart rate recovery improved in each 30-second interval of a 2-minute recovery period. The distance covered during the 6-minute walk increased from a mean of 486.3 m (±standard deviation 113.9 m) to 552.5 m (±standard deviation 111.9 m) (P < 0.001). Rating of perceived exertion during the 6-minute walk test decreased from a median of 14 (interquartile range 13-15) to 13 (interquartile range 13-13) (P = 0.001). Heart rate recovery following treadmill exercise testing improved during the 30-second periods from 60 to 90 seconds and from 90 to 120 seconds of recovery. Metabolic equivalents increased during treadmill testing from a median of 7.0 (interquartile range 5.8-8.6) to 8.6 (interquartile range 7-8.6) (P < 0.001).

Conclusions

Both treadmill exercise and 6-minute walk tests demonstrated improvements in heart rate recovery and increases in achieved workload following exercise training. This suggests that the 6-minute walk test is a valid tool to assess heart rate recovery following such a programme.     

Using Reactive Hyperemia to Assess the Efficacy of Local Cooling on Reducing Sacral Skin Ischemia Under Surface Pressure in People With Spinal Cord Injury: A Preliminary Report

Objectives

To investigate the efficacy of local cooling on reducing sacral skin ischemia in a weight-bearing position, and to identify the underlying physiological mechanisms using wavelet-based spectrum analysis of reactive hyperemia in people with spinal cord injury (SCI).

Design

Repeated-measures and before-after trial design.

Setting

University research laboratory.

Participants

Wheelchair users with SCI with injury level between C4 and T5 (n=10) and able-bodied controls (n=10).

Interventions

Three protocols consisting of pressure without temperature changes, pressure with local cooling (Δt=−10°C), and pressure with local heating (Δt=+10°C) were tested. Each protocol consisted of a 10-minute baseline period, a 20-minute loading period at 60mmHg, and a 20-minute recovery period (reactive hyperemia). A 30-minute washout period was allowed between protocols.

Main Outcome Measures

A compound sensor head consisting of laser Doppler and heating and cooling probes was used to measure sacral skin blood flow and control skin temperature. Reactive hyperemic response to pressure and temperature stimuli was characterized in the time and frequency (metabolic [.0095–.02Hz], neurogenic [.02–.05Hz], and myogenic [.05–.15Hz] components) domains.

Results

Pressure with local cooling resulted in a smaller reactive hyperemic response in both people with SCI and able-bodied controls as compared with pressure with local heating (P<.017) and pressure without temperature changes (P<.017), and the smaller hyperemia was attributed to reduced metabolic and neurogenic activities. People with SCI showed an attenuated response in reactive hyperemia (P<.017).

Conclusions

This study supports the concept of using local cooling to reduce skin ischemia under surface pressure in people with SCI.     

Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers

Purpose

Noninvasive methods that could predict preload responsiveness are lacking. Our objective was to evaluate variations in pulse oximetry plethysmographic (POP) waveform amplitude (ΔPOP) induced by passive leg raising (PLR).

Methods

We attached a pulse oximeter to the middle finger of 25 spontaneously breathing volunteers at several time points: baseline (ie, semirecumbent position), during PLR at 60° while each subject's trunk was lowered in a supine position at 1 minute, and after putting the patient back in the semirecumbent position (5-minute rest). Heart rate, noninvasive arterial pressures (mean arterial pressure and pulse pressure), maximal POP (POP_max), minimal POP (POP_min), and ΔPOP defined as [POP_max − POP_min]/[(POP_max + POP_min)/2] were recorded using a monitor.

Results

Heart rate, mean arterial pressure, pulse pressure, POP_max, and POP_min values were not different at baseline, during PLR at 1 minute, and after the 5-minute rest (repeated-measures analysis of variance). The median ΔPOP significantly decreased from 16% (95% confidence interval = 11%-23%) to 11% (95% confidence interval = 8%-14%) (P < .05) and then increased to 13% (95% confidence interval = 10%-21%) after the 5-minute rest (P = nonsignificant).

Conclusion

Passive leg raising induces a significant decrease in ΔPOP among spontaneously breathing volunteers.