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At least 343 records · Page 19Linked to original sources
PubMed2003

Specific effects of balance and gait exercises on physical function among the frail elderly.

OBJECTIVE: To evaluate the specific effects of balance and gait exercises among frail elderly individuals. DESIGN: A randomized three-group parallel controlled study. SETTING: Geriatric health services facility in Japan. SUBJECTS: Thirty-four frail elderly subjects attending the care facility were randomized into a control group, an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education. INTERVENTIONS: The two exercise groups received balance or gait exercise for 40 minutes, 2-3 times weekly, for 12 weeks. MAIN OUTCOME MEASURES: One Leg Standing Test, Functional Reach Test, Manual Perturbation Test, Functional Balance Scale, Performance-Oriented Mobility Assessment, Timed 'Up and Go' Test and Stair Climbing/Descending Test. These assessments were performed before and after 12-week intervention. RESULTS: Comparison of the performance before and after intervention demonstrated significant improvement in One Leg Standing Test, Functional Reach Test and Functional Balance Scale in the balance exercise group, and Functional Balance Scale, Timed 'Up and Go' Test and Stair Descending Test showed improvement in the gait exercise group. All test items showed no significant differences in the control groups. Among the three groups, the balance exercise group showed more significant improvement in Functional Balance Scale, and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group. The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group. CONCLUSIONS: Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.

Aged↗
PubMed2006

Effect of compensation procedures for velocity on repeatability and variability of gait parameters in normal subjects.

UNLABELLED: OBJECTIVE To evaluate the effects of a mathematical procedure that adjusts for gait velocity on the variability seen in gait analysis. DESIGN: Evaluation before and after compensation. SETTING: Gait laboratory, Fukui University Hospital, Japan. SUBJECTS: Fourteen normal volunteers. OUTCOME MEASURES: A computerized gait analysis system with two forceplates and a light source spot measuring device was used. Gait measurement in each subject was performed on three different days. RESULTS: The gait parameters measured on three different days were significantly different, particularly step length, stride length, velocity, the components of floor-reaction forces and hip motion. In these parameters, intraclass correlation coefficient, ICC (1,1) was not high (range 0.05-0.71). However, there was a high correlation between these parameters and velocity and high repeatability was obtained following compensation for velocity (ICC (1,1), range 0.73-0.97). In contrast, compensation of parameters whose measurement was not significantly different before compensation did not improve ICC (1,1). Variability of all parameters was acceptable, however CV (an index of variability) improved significantly after compensation compared with that before compensation in six of 15 parameters. CONCLUSIONS: Our findings suggest that low repeatability in gait parameters should be considered even when the gait of normal subjects is measured on different days. A high repeatability and more acceptable variability were obtained when the data were compensated for velocity.

Analysis of Variance↗
PubMed2006

Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients.

OBJECTIVE: To evaluate the immediate effects of individually designed functional in-shoe ankle-foot orthoses (AFO) made of soft and hard cast on balance, standing, and gait parameters in hemiparetic patients. DESIGN: Crossover design with randomized order of the intervention. SETTING: A rehabilitation centre for adults with neurological disorders. SUBJECTS: Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury. MEASURES: Postural sway, standing and gait parameters based on ground reaction forces in two conditions: Patients were randomly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone. RESULTS: AFO significantly improved weight-bearing on the affected leg (affected/ unaffected side symmetry: 2.25 +/- 1.5 with AFO versus 3.4 +/- 2.5 without AFO, P<0.05) and postural sway in stance (12.5 mm +/- 5.2 with AFO versus 15.7 mm +/- 6.7 without AFO, P < 0.05), double stance duration (21.1 +/-14.4% of gait cycle with AFO versus 25.9 +/- 21.6% of gait cycle without AFO, P < 0.05), and symmetry ratios of gait parameters such as stance duration (2.0 +/- 1.5 s with AFO versus 3.3 +/- 3.6 s without AFO, P < 0.05) and deceleration forces (1.6 +/- 0.5 with AFO versus 1.9 +/- 0.6 without AFO, P < 0.05) during gait. No significant differences were observed in all other symmetry ratios of gait parameters. CONCLUSION: An individually designed functional in-shoe AFO can improve stance and gait parameters, even in a single use, in patients with hemiparesis.

Adult↗
PubMed1989

Asymmetries in ground reaction force patterns in normal human gait.

The purpose of this study was to propose a measure of symmetry/asymmetry for normal human gait and to quantify symmetries/asymmetries of normal human gait for selected gait variables using a force platform. Sixty-two subjects performed ten gait trials each, stepping on the force platform five times with each leg. From these gait trials a symmetry index was calculated for 34 gait variables. The upper and lower limits of normal gait were calculated such that 95% of all symmetry indices obtained from this subject population fell within these limits. Upper and lower limits were found to vary from +/- 4% to over +/- 13,000%. Extremely high percentages were found for variables which had absolute magnitudes close to zero and/or variables which occurred at distinctly different instants during the gait cycle. The results of these variables need to be interpreted with caution.

Adult↗
PubMedDate not supplied

[Development of a gait trainer with regulated servo-drive for rehabilitation of locomotor disabled patients].

The aim of the present study was to develop a new gait trainer for the rehabilitation of non-ambulatory patients. For the simulation of the gait phase, we used a commercially available fitness trainer (Fast Track) with two foot plates moving in an alternating fashion and connected to a servo-controlled propulsion system providing the necessary support for the movement depending on the patient's impairment level. To compensate deficient equilibrium reflexes, the patient was suspended in a harness capable of supporting some of his/her weight. Video analysis of gait and the kinesiological EMG were used to assess the pattern of movement and the corresponding muscle activity, which were then evaluated in healthy subjects, spinal cord injured and stroke patients and compared with walking on the flat or on a treadmill. Walking on the gait trainer was characterised by a symmetrical, sinusoidal movement of lower amplitude than in normal gait. The EMG showed a low activity of the tibialis anterior muscle, while the antigravity muscles were clearly activated by the gait trainer during the stance phase. In summary, the new gait trainer generates a symmetrical gait-like movement, promoting weight acceptance in the stance phase, which is important for the restoration of walking ability.

Adult↗
PubMed2006

Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis.

BACKGROUND: The functional outcomes following ankle arthrodesis are not known. The purpose of the present study was to compare the intermediate-term clinical results for a group of patients in whom an ankle arthrodesis had been performed with use of modern surgical techniques with the findings for a group of healthy gender and age-matched controls on the basis of validated outcome measures and gait analysis. METHODS: Twenty-six patients who had undergone ankle arthrodesis for the treatment of isolated unilateral ankle arthritis were identified and retrospectively assessed clinically and radiographically. The mean age at the time of surgery was fifty-four years, and the mean interval between surgery and assessment was forty-four months. A gender and age-matched control group of twenty-seven individuals was recruited for comparison. All subjects were evaluated with gait analysis, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, the Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) questionnaire, and the Ankle Osteoarthritis Scale (AOS). RESULTS: On preliminary review, twenty of the twenty-six patients were completely satisfied or satisfied with their surgical outcome. All patients but one stated that they would undergo the surgery again. Five patients stated that they did not notice a gait abnormality. Twelve patients wore orthotics, and all believed that the use of the orthotics improved their gait. When the functional outcome scores in the arthrodesis group were compared with those in the control group, specific scores assessing hindfoot pain and satisfaction were similar. However, scores focusing on ankle-hindfoot function and disability revealed significant differences. Gait analysis also identified significant differences between the two groups with regard to cadence and stride length. In addition, there was significantly decreased sagittal, coronal, and transverse range of motion of the hindfoot and midfoot during the stance and swing phases of gait in the arthrodesis group. Radiographic review demonstrated that four of the twenty-six patients had development of moderate to severe arthritis of the subtalar joint. CONCLUSIONS: In the intermediate term following an arthrodesis for the treatment of end-stage ankle arthritis, pain is reliably relieved and there is good patient satisfaction. However, there are substantial differences between patients and the normal population with regard to hindfoot function and gait. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function; however, it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of ipsilateral hindfoot arthritis.

Adolescent↗
PubMed2006

Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery.

BACKGROUND: Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. Multilevel orthopaedic surgery has been used to correct severe crouch gait, but no cohort studies or long-term results have been reported, to our knowledge. METHODS: In order to be eligible for the present retrospective cohort study, a patient had to have a severe crouch gait, as defined by sagittal plane kinematic data, that had been treated with multilevel orthopaedic surgery as well as a complete clinical, radiographic, and instrumented gait analysis assessment. The surgical intervention consisted of lengthening of contracted muscle-tendon units and correction of osseous deformities, followed by the use of ground-reaction ankle-foot orthoses until stable biomechanical realignment of the lower limbs during gait was achieved. Outcome at one and five years after surgery was determined with use of selected sagittal plane kinematic and kinetic parameters and valid and reliable scales of functional mobility. Knee pain was recorded with use of a Likert scale, and all patients had radiographic examination of the knees. RESULTS: Ten subjects with severe crouch gait and a mean age of 12.0 years at the time of surgery were studied. After surgery, the patients walked in a more extended posture, with increased extension at the hip and knee and reduced dorsiflexion at the ankle. Pelvic tilt increased, and normalized walking speed was unaltered. Knee pain was diminished, and patellar fractures and avulsion injuries healed. Improvements in functional mobility were found, and, at the time of the five-year follow-up, fewer patients required the use of wheelchairs or crutches in the community than had been the case prior to intervention. CONCLUSIONS: Multilevel orthopaedic surgery for older children and adolescents with severe crouch gait is effective for relieving stress on the knee extensor mechanism, reducing knee pain, and improving function and independence.

Adolescent↗
PubMed1998

A "step-to" gait decreases pressures on the forefoot.

Physical therapists use various gait training strategies to reduce stress on the lower extremities, but we could find no description or evaluation of the step-to gait using a cane. The purpose of this study was to evaluate the effect of a step-to gait pattern and a cane on peak plantar pressures on the forefoot and the heel. Ten healthy subjects were evaluated (five females, five males, mean age = 24.6 +/- 4.9 years). In addition, one subject with peripheral neuropathy was tested to determine if a patient could be trained to use the step-to walking pattern and show similar results. All subjects were instructed in four walking conditions; step-to with and without a cane and step-through with and without a cane. Walking speed during the step-through pattern (normal walking) was matched to the speed of the step-to pattern. For the 10 healthy subjects, peak plantar pressures and walking speed of each of the four conditions were compared using a 2 x 2 repeated measures analysis of variance. One factor was gait pattern and one factor was use of a cane. Peak plantar pressures decreased an average of 53% on the forefoot but increased an average of 14% on the heel when subjects walked using step-to gait compared with a step-through gait. There was no effect due to use of a cane or walking speed between the conditions. The patient with peripheral neuropathy demonstrated a similar pattern but greater magnitude of changes compared with the healthy subjects. The foot initiating the step-to pattern showed a reduction in peak plantar pressures on the forefoot, probably because the foot remained flat during stance phase and a large push-off was not required. The step-to pattern, however, results in a slower and less symmetrical gait. The use of a step-to gait may be beneficial for patient populations that need to reduce plantar pressures on the forefoot.

Adult↗
PubMed2002

[Evaluation of unilateral total hip arthroplasty by a quantitative analysis of gait].

OBJECTIVES: The purpose of this prospective study was to assess changes in gait parameters after unilateral total hip arthroplasty and to correlate these objective changes with the results of subjective analyses. METHODS: Thirty-eight patients (21 women, 17 men; mean age 61 years) with unilateral degenerative hip disease were evaluated in order to investigate preoperative and postoperative gait characteristics with the use of a gait evaluation mat (Gait Rite, USA). Each patient underwent at least two postoperative gait evaluations in the sixth and twelfth months, respectively. Gait evaluations were also made in a control group of 50 individuals without any neuromuscular and skeletal disease. Clinical evaluations were made using the Harris hip scoring system. RESULTS: All patients exhibited poor subjective evaluations preoperatively (Harris hip score <70). Compared to controls, patients had decreased step length and velocity, but increased stance, step, double support and swing times. Postoperatively, gait characteristics did not differ from those elicited prior to surgery in the first six months; however, patients attained near-normal velocity in the twelfth month. The recorded values for step length, step time, and double support time were similar to those of controls in both extremities. CONCLUSION: This study showed that total hip arthroplasty considerably improved the gait characteristics of patients with degenerative arthritis, and that this improvement could be measured and recorded quantitatively with the use of a walking band.

Arthroplasty, Replacement, Hip↗
PubMed1992

[Gait pattern of patients with hip arthritis].

Automatic recording of the kinematic and kinetic gait pattern has so far not been commonly used in the diagnosis of problems affecting the human loco motor apparatus. In recent decades gait analysis has increasingly been applied in the development of endoprostheses and sports shoes and in rehabilitation, especially of patients with neurological diseases. When a gait laboratory is set up, this demands interdisciplinary cooperation, biomechanical knowledge in physicians and (physio-)therapists, and elaboration of treatment plans allowing direct therapeutic exploitation of the gait data. There are determinant factors in gait pattern, which does not vary qualitatively in the sagittal plane (flexion/extension) with sex and age until the age of 70 years. Quantitatively there is a great deal of individual variation, and the diagnosis of a pathologic function in a particular patient can be difficult. A normal reference population was used to determine the gait pattern characteristic for 32 patients with osteoarthritis of the hip on one or on both sides, and the possible significance of the results for physical and surgical therapy is discussed. The main characteristic of this gait pattern ist the limitation of hip extension before toe-off in the late stance phase. One-third of the patients answer compensate with this increased hip flexion at heel strike, which in turn leads to an increased load on the (more severely) affected side. In consequence, the increased load might lead to progression of the osteoarthritis. In the development of endoprostheses it should be borne in mind that the design may influence the gait pattern, producing overloading of the extremity and perhaps reducing the life of the prosthesis.

Adult↗
PubMed2006

Correlation between gait and balance in people with and without Type 2 diabetes in normal and subdued light.

BACKGROUND: Balance and gait are both impaired in people with diabetes but no study has examined both in the same subjects in people either with or even without diabetes or related these to room lighting. MATERIAL/METHODS: Twelve subjects with type 2 diabetes (D) and 15 age-matched controls (C) were examined under conditions of full light, eyes closed (no light) and low light (5 candle power). Balance was assessed during standing by a computerized posturography device. Gait was analyzed during the initiation of movement, while walking at uniform speed and during turns of 0.66 meters diameter through accelerometers, foot contact sensors and the electomyogram recorded from the gastrocnemius and tibialus anterior muscles. RESULTS: Subjects with diabetes had poorer balance during standing in diminished light compared to full light and no light conditions. When the room light was dimmed, sway during standing increased by an average of 25% in D. Control subjects did not have different sway with diminished light compared to the other lighting conditions. Gait was slower, circumduction greater and muscle use greater in D than C. There was a significant negative correlation between balance and gait; the worse the balance, the slower and poorer the gait for both groups of subjects (p<0.05), impaired balance accounting for 70% of the deviation in gait in D whereas it only accounted for 52% in C. CONCLUSIONS: Balance and gait are related in people with and without diabetes. Diabetes causes balance and gait to both be impaired compared to C.

Adult↗
PubMed1995

Gait parameters following stroke: a practical assessment.

Mechanical methods of quantifying gait are more sensitive to change than is direct clinical inspection. To assess gait parameters and patterns of patients with stroke, and the temporal changes of these parameters, a foot-switch gait analyzer was used to test 49 ambulatory patients with stroke and 24 controls. Patients walked significantly slower than controls, with decreased cadence, increased gait cycle, and increased time in double limb support. Patients' hemiplegic limbs spent more time in swing and stance when compared to controls; their unaffected limbs spent significantly more time in stance and single limb support compared to controls. Patients' hemiplegic side, when compared with the unaffected side, spent less time in stance and more time in swing. A flatfoot pattern was typically noted on the affected side. General gait parameters improved over time, with the largest changes occurring in the first 12 months. However, the percentage of time spent in double and single limb support, stance and swing, parameters which describe the asymmetrical pattern of gait, did not change over time. Abnormal gait was due to difficulty in moving the body over an unstable limb. Gait analysis can be of importance in documenting abnormalities and determining the effects of therapeutic modalities.

Adult↗
PubMed1993

Knowledge base for diagnostic gait assessments.

Clinical gait laboratories have proliferated over the past two decades and an increasing number of research papers are reporting 'assessments' of pathological gait. Some criticisms have been levied at the value of most of these assessments, and some of their arguments are justified. Unfortunately, their review of the pathological gait literature was too superficial for them to justify their main conclusions. The purpose of this review is three fold. The first goal is to show that clinical gait assessments, properly done, do yield valuable diagnostic information to assist surgeons in planning orthopaedic procedures, in the planning of rehabilitation and in the assessment of prosthetic devices. The second goal is to present specific examples of pathological gait assessment to demonstrate the need to understand the fundamental goals and sub-tasks involved in walking, normal gait synergies and the value of a normalized data base. Finally, a generalized strategy will be demonstrated through the use of a diagnostic checklist that has been developed for all gait pathologies. This latter goal is logistically and financially important when we consider the high equipment and personnel costs of running a diagnostic gait service.

Adult↗
PubMed1993

[Impaired gait after base fractures of the 5th metatarsal bone].

Between 1982 and 1990, twenty fractures of the base of the fifth metatarsal were treated operatively and followed up for a mean of 4.5 years (range: 1-9 years). All patients were evaluated clinically, roentgenographically and with kinetic gait analysis. A scoring system was used to record and evaluate the clinical and radiological data. Nine patients had an excellent result and nine a good result; one patient had a fair and one a poor result. Examination by kinetic gait analysis showed a gait asymmetry in eleven of the twenty patients, with decreased load on the formerly injured areas of the involved foot and increased load on the corresponding areas of the contralateral foot. However, only three patients had a clinically visible gait disorder. We believe that the gait disorder described is an automatically adopted movement pattern. Its cause lies in the initial pain after the trauma and during the postoperative care and sometimes continues even after the cessation of pain. Kinetic gait analysis allows quantification of asymmetry of gait and clinically non-visible load disorder. Therefore, pain and established gait asymmetry are clinically relevant in such patients because they can be treated specifically.

Adolescent↗
PubMed1993

[Dynamic roles of the upper extremity during axillary crutch gait].

To ambulate successfully with an axillary crutch, the upper extremities play an important part in supporting the body's entire weight. To evaluate the roles of the upper extremity during axillary crutch gait 15 normal adult subjects, 23 patients with an affected single leg, and 3 patients with rheumatoid arthritis (RA), were investigated. The gait patterns using crutches were: the one-leg swing-through crutch gait and three-point crutch gait for both normal subjects and patients with an affected single leg, and the three-point crutch gait for RA patients. The real-time motion analysis system "Quick-MAG", force plates, and a VTR system were used for data acquisition. The forces at the arm-pit and the hands during the swing-through crutch gait decreased when the cadence increased from 60 to 100 steps per minute. However, the floor reaction curve suggested distortion of the rubber at the crutch tip when the cadence reached 100. In the plane of progression during the crutch stance phase, the elbow flexion angle was about 14 degrees, and the wrist radial flexion angle about 23 degrees in the middle of the crutch stance phase. This position might be the best for efficient force exertion from the upper extremity. The unloading ratio during the three-point crutch gait was 35 percent in the normal subjects, 49 percent in patients with an affected single leg, and 14 percent in the RA patients. The results of the unloading ratio, indicated that elbow and wrist joint impairment prevented the RA patients from sustaining enough posture to support body weight during the three-point crutch gait.

Adolescent↗
PubMed1995

[Idiopathic scoliosis by spinal fusion and brace treatment: evaluation by gait analysis].

UNLABELLED: We have investigated the differences in gait between 68 idiopathic scoliosis patients and 186 normal subjects, and differences in gait before and after treatment of the scoliosis by two different methods. The idiopathic scoliosis patients were divided into two groups according to which treatment they had received; one group of 17 cases had been treated by spinal fusion and the other group of 51 cases had been treated by bracing. Gait analysis was performed using a 1.2 m wide and 10.8 m long force plate walkway. Three components of each step (the lateral, horizontal and vertical components) were measured. Gait velocity, step length, step width and cadence were evaluated as temporal and distance factors, and symmetry, reappearance, smoothness, sway, rhythm and impact were evaluated as gait factors. RESULTS: Before treatment, there was no difference in any temporal or distance factor between the scoliosis patients and the normal subjects. However, the index of symmetry, and of sway, in the vertical component prior to treatment in the scoliosis patients was significantly inferior to that in the normal subjects. A positive correlation was found between the index of sway in the vertical component and the pretreatment Cobb angle. This correlation was found in the right-convex single curve group and in the double curve group, but not in the left-convex single curve group. After spinal fusion, the step width became wider and the index of sway significantly improved, but index of symmetry was unchanged. No gait factor became worse postoperatively. In contrast, in the bracing group, the step width became wider, but the index of symmetry, and of sway in the vertical component, did not improve with the brace. The gait of scoliosis patients could be objectively and quantitatively analyzed by the force plate. The gait analysis was useful for evaluating the effects of spinal fusion, and of brace treatment, in idiopathic scoliosis patients.

Adolescent↗
PubMedDate not supplied

Does gait continue to improve 2 years after selective dorsal rhizotomy?

Although changes in the gait pattern of children with spastic diplegia 1 year after selective dorsal rhizotomy have been well documented, minimal information exists regarding the continued changes in the gait pattern over time. Despite improvements in gait after rhizotomy, 66-75% of patients still require orthopaedic surgery for residual deformities. The optimal timing of the orthopaedic surgery after selective dorsal rhizotomy is not well established because of the lack of information regarding changes in gait over a long term. Using three-dimensional gait analysis, the gait pattern of 23 children was evaluated preoperatively, 1 and 2 years postoperatively. There were significant improvements in hip, knee, and ankle motion at 1 year after surgery. Although improvements in the gait pattern were found between 1 and 2 years after surgery, the changes were not significant. Therefore orthopaedic intervention may be undertaken at 1 year after rhizotomy to enhance function, as changes in gait from 1 to 2 years after rhizotomy are minimal.

Cerebral Palsy↗
PubMed1998

A new gait parameterization technique by means of cyclogram moments: Application to human slope walking.

A new parameterization technique for the systematic characterization of human walking gait in diverse external conditions is proposed in this work. By parameterization we mean a quantitative expression of certain gait descriptors as the function of an external parameter, such as the ground slope. The mathematical quantifies derived from the geometric features of the hip-knee cyclograms are the main gait descriptors considered in this study. We demonstrate that these descriptors, expressed in a general setting as the geometric moments of the cyclogram contours, can meaningfully reflect the evolution of the gait kinematics on different slopes. We provide a new interpretation of the cyclogram perimeter and discover two potential invariants of slope-walking gait. Experimental slope-walking data obtained for each 1 degrees interval within the range of -13 to +13 degrees (+/-23.1%) on a variable-inclination treadmill was used in this study. The parameterization procedure presented here is fairly general in nature and may be employed without restriction to any closed curve such as the phase diagram, the moment-angle diagram, and the velocity-velocity curves of human gait. The technique may be utilized for the quantitative characterization of normal gait, global comparison of two different gaits, clinical identification of pathological conditions and for the tracking of progress of patients under rehabilitation program. Copyright 1998 Elsevier Science B.V.

Journal Article↗