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At least 37 records · Page 2Linked to original sources
PubMed2006

Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial.

OBJECTIVE: To compare the therapeutic effects of conventional gait training (CGT), gait training using an electromechanical gait trainer (EGT), and gait training using an electromechanical gait trainer with functional electric stimulation (EGT-FES) in people with subacute stroke. DESIGN: Nonblinded randomized controlled trial. SETTING: Rehabilitation hospital for adults. PARTICIPANTS: Fifty patients were recruited within 6 weeks after stroke onset; 46 of these completed the 4-week training period. INTERVENTION: Participants were randomly assigned to 1 of 3 gait intervention groups: CGT, EGT, or EGT-FES. The experimental intervention was a 20-minute session per day, 5 days a week (weekdays) for 4 weeks. In addition, all participants received their 40-minute sessions of regular physical therapy every weekday as part of their treatment by the hospital. MAIN OUTCOME MEASURES: Five-meter walking speed test, Elderly Mobility Scale (EMS), Berg Balance Scale, Functional Ambulatory Category (FAC), Motricity Index leg subscale, FIM instrument score, and Barthel Index. RESULTS: The EGT and EGT-FES groups had statistically significantly more improvement than the CGT group in the 5-m walking speed test (CGT vs EGT, P=.011; CGT vs EGT-FES, P=.001), Motricity Index (CGT vs EGT-FES, P=.011), EMS (CGT vs EGT, P=.006; CGT vs EGT-FES, P=.009), and FAC (CGT vs EGT, P=.005; CGT vs EGT-FES, P=.002) after the 4 weeks of training. No statistically significant differences were found between the EGT and EGT-FES groups in all outcome measures. CONCLUSIONS: In this sample with subacute stroke, participants who trained on the electromechanical gait trainer with body-weight support, with or without FES, had a faster gait, better mobility, and improvement in functional ambulation than participants who underwent conventional gait training. Future studies with assessor blinding and larger sample sizes are warranted.

Adult↗
PubMed2004

Effect of gait cycle selection on EMG analysis during walking in adults and children with gait pathology.

This paper presents the results of a project to evaluate different methods of gait cycle selection on the analysis of electromyography recorded during gait. Electromyography (EMG) describes the electrical activity associated with the muscle and is often interpreted in gait analysis using a simultaneously obtained signal to identify phases of the gait cycle. Phase transitions are often selected manually from reference signals derived from additional instrumentation, such as pressure platforms, footswitches and video cameras. We propose two methods (automatic and semi-automatic) as an alternative to the more traditional manual selection, and analyse how the gait cycle selection affects the EMG analysis. To quantify the differences between the gait cycles obtained using each method and to classify each cycle, three indices have been introduced. The effect of the gait cycle selection has been evaluated with respect to the EMG step profiles and temporal gait descriptors. An asymptomatic adult, an asymptomatic child and two children with cerebral palsy were examined using telemetric EMG devices and pressure footswitches. The results obtained showed that the method of gait cycle selection did not have a major influence for the adult, but it altered considerably the analysis in the case of the children with cerebral palsy.

Adult↗
PubMedDate not supplied

Idiopathic gait disorder among in-patients with acquired gait disorders admitted to a children's hospital.

Many children are admitted to hospital for treatment of an acquired gait disorder. Some gait disorders have a definite underlying physical cause and some are idiopathic. A literature review shows that there have been few attempts to estimate the incidence or prevalence of idiopathic gait disorder in children. The economic and social impact may be substantial with regard to therapy and investigations and school absence, respectively. This study attempted to estimate the incidence and impact of idiopathic gait disorder in a tertiary children's hospital. It evaluated prospectively all the children admitted with a gait disorder requiring physiotherapy treatment at Birmingham Children's Hospital, using a standardized pro-forma, during a 3-month period between March-June 1999. One hundred and three children (aged 2-16 years) were admitted with gait disorders (57 female and 46 male). Eight had an idiopathic gait disorder. All eight children exhibited significant functional impairment, pain and school absence. Idiopathic gait disorder accounted for 8% of children admitted to hospital with an acquired gait disorder and had an annual incidence of at least 2-4 per 100,000 children. The economic and social impact of these disorders is, therefore, substantial, especially with regard to diagnosis, investigations, treatment and school absence.

Adolescent↗
PubMed2001

An electromechanical gait trainer for restoration of gait in hemiparetic stroke patients: preliminary results.

Modern concepts of gait rehabilitation after stroke favor a task-specific repetitive approach. In practice, the required physical effort of the therapists limits the realization of this approach. Therefore, a mechanized gait trainer enabling nonambulatory patients to have the repetitive practice of a gait-like movement without overstraining therapists was constructed. This preliminary study investigated whether an additional 4-week daily therapy on the gait trainer could improve gait ability in 14 chronic wheelchair-bound hemiparetic subjects. The 4 weeks of physiotherapy and gait-trainer therapy resulted in a relevant improvement of gait ability in all subjects. Velocity, cadence, and stride length improved significantly (p < 0.01). The kinesiologic electromyogram of selected lower-limb muscles revealed a more physiologic pattern. The confounding influence of spontaneous recovery, the lack of a control group, and the double amount of therapy limit the clinical relevance of this study. Nevertheless, the gait trainer seems feasible as an adjunctive tool in gait rehabilitation after stroke; further studies are needed.

Adult↗
PubMed2001

[Gait disorders in Parkinson disease. Gait freezing and falls: therapeutic management].

GAIT ARRESTS: They affect the evolution of the disease. This freezing phenomenon which induces falls sometimes constitutes an initial sign. Like the gait initiation failure, freezing can be controlled by sensory stimulation, notably visual inputs, but also by more sustained attention. FALLS ARE MAINLY CONNECTED WITH BOTH POSTURAL INSTABILITY AND RIGIDITY: They are poorly influenced by dopaminergic therapies. The progressive decrease of step width represents a main factor in their occurrence. PRECOCITY OF GAIT DISORDERS IS UNUSUAL IN PARKINSON'S DISEASE: Other parkinsonian syndromes such as progressive supranuclear palsy, multiple system atrophy and vascular parkinsonian syndrome must then be evoked. Their association with a cognitive impairment and abnormal sphincter behaviour infers a diagnosis of normal pressure hydrocephalus. GAIT IMPROVES WITH L-DOPA THERAPY: Speed, step length and duration of the swing phase are increased without change of cadence. Progressive loss of L-dopa efficiency on gait and postural stability contrasts with the persistent effect on tremor, rigidity and bradykinesia; a functional abnormality of nondopaminergic systems can explain these symptoms. In the following stages, gait troubles increased by motor fluctuations and abnormal involuntary movements are less controlled by L-dopa therapy. PHYSICAL THERAPY PLAYS A MAJOR ROLE IN THERAPEUTIC MANAGEMENT: An individual or collective rehabilitation project must be established according to the stage of evolution; the exercises aim to protect postural control and coordination. Visual or sound rhythmic inputs can be employed in the case of gait initiation failure. THE EFFECTS OF FUNCTIONAL NEUROSURGERY ARE IN THE COURSE OF EVALUATION: Thermolesion and chronic electrical stimulation of deep brain structures have opposite effects on gait troubles. Bilateral thalamotomy or pallidotomy are sometimes a source of disequilibrium. Chronic thalamic stimulation does not induce either benefits or adverse effects. On the other hand, stimulation of the internal pallidum improves gait kinematic parameters; improved postural adjustments have also been reported. The effect of subthalamic nucleus stimulation is comparable to that of L-dopa, however the long-term effect remains to be evaluated.

Accidental Falls↗
PubMed2005

Shedding light on walking in the dark: the effects of reduced lighting on the gait of older adults with a higher-level gait disorder and controls.

OBJECTIVE: To study the effects of reduced lighting on the gait of older adults with a high level gait disorder (HLGD) and to compare their response to that of healthy elderly controls. METHODS: 22 patients with a HLGD and 20 age-matched healthy controls were studied under usual lighting conditions (1000 lumens) and in near darkness (5 lumens). Gait speed and gait dynamics were measured under both conditions. Cognitive function, co-morbidities, depressive symptoms, and vision were also evaluated. RESULTS: Under usual lighting conditions, patients walked more slowly, with reduced swing times, and increased stride-to-stride variability, compared to controls. When walking under near darkness conditions, both groups slowed their gait. All other measures of gait were not affected by lighting in the controls. In contrast, patients further reduced their swing times and increased their stride-to-stride variability, both stride time variability and swing time variability. The unique response of the patients was not explained by vision, mental status, co-morbidities, or the values of walking under usual lighting conditions. CONCLUSION: Walking with reduced lighting does not affect the gait of healthy elderly subjects, except for a reduction in speed. On the other hand, the gait of older adults with a HLGD becomes more variable and unsteady when they walk in near darkness, despite adapting a slow and cautious gait. Further work is needed to identify the causes of the maladaptive response among patients with a HLGD and the potential connection between this behavior and the increased fall risk observed in these patients.

Journal Article↗
PubMedDate not supplied

Gait in children with cerebral palsy: observer reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing scale.

The aim of this study was to test the inter- and intraobserver reliability of the Physician Rating Scale (PRS) and the Edinburgh Visual Gait Analysis Interval Testing (GAIT) scale for use in children with cerebral palsy (CP). Both assessment scales are quantitative observational scales, evaluating gait. The study involved 24 patients ages 3 to 10 years (mean age 6.7 years) with an abnormal gait caused by CP. They were all able to walk independently with or without walking aids. Of the children 15 had spastic diplegia and 9 had spastic hemiplegia. With a minimum time interval of 6 weeks, video recordings of the gait of these 24 patients were scored twice by three independent observers using the PRS and the GAIT scale. The study showed that both the GAIT scale and the PRS had excellent intraobserver reliability but poor interobserver reliability for children with CP. In the total scores of the GAIT scale and the PRS, the three observers showed systematic differences. Consequently, the authors recommend that longitudinal assessments of a patient should be done by one observer only.

Cerebral Palsy↗
PubMed2001

Microprocessor-based gait analysis system to retrain Trendelenburg gait.

A microprocessor-based gait analysis system is described that uses two electromyogram (EMG) amplifiers, two foot switches and an audio feedback device to allow the retraining of one type of improper gait, where the hip abductors (gluteus medius muscles) are weak on one side of the body, causing the opposite hip to drop during the swing phase of gait (Trendelenburg gait). As the abnormality is strictly on one side of the body in most people, the circuitry is minimised, as gait can be analysed by only comparing muscle activity in the affected gluteus medius muscle with that in the unaffected gluteus medius muscle, through the EMG. Two foot contact switches are used to help assess timing of the step cycle. If gait is different on the two sides of the body, an audio cue directs the patient to correct the abnormality by increasing activity on the affected side. The device is tested on five patients. Trendelenburg gait is reduced by an average of 29 degrees through the use of the device. The average stride length at the beginning of the study is 0.32 +/- 0.3 m. By the end of the study, the stride length is increased to 0.45 +/- 0.2 m for the entire group of five subjects. The speed of gait has increased from 1.6 +/- 0.4 kmh(-1) to 3.1 +/- 0.5km h(-1).

Adult↗
PubMed1999

Quantitative evaluation of gait pattern in patients with osteoarthrosis of the knee before and after total knee arthroplasty. Gait analysis using a pressure measuring system.

Using a pressure measuring system, we quantitatively evaluated gait pattern in patients with osteoarthrosis (OA) of the knee before and after total knee arthroplasty (TKA). In the OA group, the stance time was longer, and the average vertical component of the floor reaction force (AVF) was lower than the values in normal age-matched subjects. These gait parameters correlated with the clinical score. These results suggest that changes in the gait parameters reflect gait patterns that reduce load on the knee. The center of pressure (COP) under the foot was correlated with the axial alignment of the lower limb in the mid-stance phase. In the TKA group, the clinical scores and gait parameters were improved 12 months after surgery compared with the preoperative values. The COP in the mid-stance phase moved inward after the TKA. However, in patients examined more than 2 years after a TKA, stance time and AVF did not reach normal levels, despite the patients' good clinical scores. These findings indicate that the gait pattern before surgery continues although pain on walking is reduced early after a TKA. Gait evaluation with a simple pressure measuring system revealed the changes in gait that are difficult to define by subjective clinical assessment.

Aged↗
PubMed2004

Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait.

Crouch gait, a troublesome movement abnormality among persons with cerebral palsy, is characterized by excessive flexion of the hips and knees during stance. Treatment of crouch gait is challenging, at present, because the factors that contribute to hip and knee extension during normal gait are not well understood, and because the potential of individual muscles to produce flexion or extension of the joints during stance is unknown. This study analyzed a three-dimensional, muscle-actuated dynamic simulation of walking to quantify the angular accelerations of the hip and knee induced by muscles during normal gait, and to rank the potential of the muscles to alter motions of these joints. Examination of the muscle actions during single limb stance showed that the gluteus maximus, vasti, and soleus make substantial contributions to hip and knee extension during normal gait. Per unit force, the gluteus maximus had greater potential than the vasti to accelerate the knee toward extension. These data suggest that weak hip extensors, knee extensors, or ankle plantar flexors may contribute to crouch gait, and strengthening these muscles--particularly gluteus maximus--may improve hip and knee extension. Abnormal forces generated by the iliopsoas or adductors may also contribute to crouch gait, as our analysis showed that these muscles have the potential to accelerate the hip and knee toward flexion. This work emphasizes the need to consider how muscular forces contribute to multijoint movements when attempting to identify the causes of abnormal gait.

Acceleration↗
PubMedDate not supplied

Calcaneal gait in spastic diplegia after heel cord lengthening: a study with gait analysis.

Calcaneal gait or deformity can be a significant complication after heel cord lengthening. After heel cord lengthening, 20 children with spastic diplegia were evaluated by gait analysis to define calcaneal gait objectively and describe associated morbidity. Mean age was 5 years 2 months (range 2 years 7 months to 8 years 2 months), and mean length of follow-up was 5 years 8 months (range 1 years 1 month 11 year 3 months). Calcaneal gait was defined as dorsiflexion 1 SD beyond the mean in the sagittal plane for all phases of stance. Increased ankle dorsiflexion during mid-stance most accurately predicts calcaneal gait. Through gait analysis, a 30% (6 of 20) prevalence of calcaneal gait suggests that an increased incidence of calcaneal gait may be present after heel cord lengthening.

Cerebral Palsy↗
PubMed2001

[Gait disorders in Parkinson disease. Neuroanatomic and physiologic organization of gait].

GAIT IS A VOLUNTARY, AUTOMATIC AND REFLEX RHYTHMIC ACTIVITY: It is generated by a central pattern generator identified from animal models. This spinal gait generator (SGG) is controlled by various parts of the central nervous system: the descending tracts and locomotor regions of the brainstem, the cerebellum, the basal ganglia, the motor and parietal cortex and the hippocampus. Kinesthetic inputs which project to the SGG and the cerebellum, play an important role in the production of postural reflex responses; vestibular and visual inputs mainly control balance. GAIT MAINLY DEPENDS ON THE RELATIONSHIP BETWEEN POSTURE BALANCE AND MOVEMENT: As concerns posture each segment is under the control of both peripheral and central nervous systems and is used as a system of reference to organize movements of adjacent segments. Balance is maintained by sensory inputs which provide corrective mechanisms: anticipatory postural responses, reflex postural responses and voluntary responses. DIFFERENT DESCRIPTIVE PARAMETERS MAY BE PROPOSED: Analysis of kinematic (displacement, speed and acceleration of segments) and kinetic parameters during the four successive stages of gait (posture, initiation, rhythmic gait and return to the initial posture) provides an understanding of neurological gait disorders. In particular the relationship between the center of pressure and the center of gravity is used to analyze infraclinical gait abnormalities. NEW AND SOPHISTICATED INVESTIGATIONS METHODS ARE AVAILABLE: The optoelectronic system provides a tridimensional analysis of movement and can be combined with forceplate and electromyographic recordings. These methods constitute an interesting contribution to the clinical analysis of gait. CLASSIFICATION: This is established according to clinical data and the positionment of the lesion among the structures of the nervous system. The physiopathological approach is then specified taking into account the lesions of the muscular, skeletal and nervous structures.

Brain↗
PubMed1977

Standardization of kinematic gait measurements and automatic pathological gait pattern diagnostics.

The estimation of patients gait in the field of rehabilitation is the starting point for an appropirate therapy decision and convenient prosthesis or orthosis choice. The measurement and estimation of human locomotion is increasingly being transferred to every day clinical use. In recent times many systems are intended for kinematic gait parameters measurements: stroboscopic photography, movie camera, TV picture analysis, TV signal analysis, chronocyclographical measurement, polarised light goniometer, the "Selspot" system, parallelgram goniometers, exoskeleton goniometers. In the paper the role of the computer in gait measurements is also determined. The problems of the choice of parameters to be measured, unique reference coordinate systems and normal gait pattern are encountered in this work. Finally two versions of pathological gait pattern estimation are described: clinical gait analysis and mathematical quantitative gait analysis. A combination of both methods provides an efficient, compact automatic pathological gait pattern diagnostics.

Automation↗
PubMed2000

A mechanized gait trainer for restoring gait in nonambulatory subjects.

OBJECTIVE: To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. PATIENTS: Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. INTERVENTION: Four weeks of training, five times a week, each session 20 minutes long. MAIN OUTCOME MEASURES: Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. RESULTS: Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. CONCLUSION: The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.

Equipment Design↗
PubMed2006

Does clinic-measured gait speed differ from gait speed measured in the community in people with stroke?

OBJECTIVE: To compare the extent to which gait speed measured in the clinic setting differs from that measured in the community. DESIGN: Participants completed the 10-m walk test at a self-selected speed in a clinic SETTING. Following this they completed a 300-m community-based walking circuit that covered a variety of environmental conditions. Gait velocity was sampled at different points in the circuit. The same circuit and sampling points were used for all participants. Clinic gait velocity was compared to gait velocity measured on five occasions during the community-based circuit. SETTING: Physiotherapy clinic and local shopping mall. PARTICIPANTS: Twenty-eight chronic stroke patients who regularly accessed the community divided into two groups based on their gait velocity in the clinic. MAIN OUTCOME MEASURES: Walking velocity. RESULTS: Spearman rank correlation coefficient indicated that there was a strong correlation between the total time taken to walk the 300-m course and the clinic-based gait velocity (r = -0.88, P < 0.0001). A linear mixed model with repeated measures analysis revealed significant interaction between community measures for group A versus group B (F4,26 = 4.49, P = 0.0068) and significant differences across community conditions (F4,26 = 7.12, P = 0.0005). CONCLUSION: The clinic-based 10-m walk test is able to predict walking velocity in a community setting in chronic stroke patients who score 0.8 m/s or faster. However, for those who score less than 0.8 m/s in the clinic test, gait velocity in the community may be overestimated.

Aged↗