HYPNOSIS AND FUNCTIONAL GAIT HABITS. GAIT CONTROL WITH POSTHYPNOTIC SUGGESTION.
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The pace analysis of patients with a total hip replacement has been carried out by means of the electroichnograph EKIG-3 of the Riga Institute of Orthopaedics and Traumatology. It comprises foot analysis (heel torsion, sole exercise, ball torsion, contact ability by using special sandals) on an electrically flowed carpet. Furthermore, angular changes in the knee-joint have been registered by means of goniometers, and the trunk deviation to the lateral an sagittal direction has also been measured.
35 patients have been examined before the implantation of a total hip replacement, about 7 days postoperatively and again after 12 weeks by means of the electro-ichnograph EKIG-3 of the Riga Institute of Orthopaedics and Traumatology. Before the hip-joint substitution the normal values could not approximately be attained. The step duration has postoperatively increased, and it has decreased to pre-operative values by the time of the follow-up examination. The best results were obtained concerning the change of the trunk deviation in the frontal plane. The hip mobility measured passively was remarkably better after the operation and almost reached normal values. Regarding the results it should above all be taken into consideration, that the most important fact for the patient is the alleviation and elimination of pain, respectively.
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Walking patterns of fifty-seven normal children were studied using large-sized force plates and compared with those of normal adults. In the vertical component of the ground reaction force, the peak of the deceleration phase was higher than that of the acceleration phase in younger children. In the sagittal component, the peak of the deceleration phase was higher than that of the acceleration phase, particularly in younger children. The point of change from the deceleration phase to the acceleration phase appeared earlier than that of adults. The lateral component in younger children was relatively larger than that of the older children and adults. The period of change from the child walking pattern to the adult walking pattern in each component was as follows:--In the sagittal component it was about five years of age, in the vertical component at about six years of age and in the lateral component at about nine years of age.
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We investigated 42 juvenile patients with idiopathic scoliosist, 37 of them were provided with a Milwaukee brace and treated physically. The electromyographic activity of the musculi erectores trunci and the musculi glutaei medii were recorded during walking and standing on one leg. Simultaneously the motions of the trunc and the pelvis in the frontal plane were registered and calculated. Results without the brace: During walking the activity of the erectors trunci predominates on the convex side of the curvature of the spine. This applies as to the functional curve. The M. glutaeus medius shows an increased activity on the contralateral side of the overhang of the trunc. The priodical shifts of the trunc to the right and to the left during walking decrease with increasing activity of the M. glutaeus medius. In this way, we show the stabilizing influence of this muscle upon the statics of the spine. This should be especially considered with regard to the physical treatment of the patients. Results with the brace put on: There is only little influence of the brace upon the electrical activity of the musculi erectores trunci: we could not detect any activating ore inactivating effect of the brace. The amplitude of the periodical shifts of the trunc and the perlvis during walking is reduced by the brace. At the same time we found a greater activity of the musculi glutaei medii than with the brace taken off. We suppose that the reduced shifts of the trunc and the pelvis involved by the brace force a greater activity of the glutaeus medius.
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Patients with Parkinson's disease (PD) often experience freezing of gait, a debilitating phenomenon during which the subject suddenly becomes unable to start walking or to continue to move forward. Little is known about the gait of those subjects with PD who experience freezing of gait or the pathophysiology of freezing. One possibility is that freezing of gait is a truly paroxysmal phenomenon and that the usual walking pattern of subjects who experience freezing of gait is not different than that of other patients with PD who do not experience these transient episodes of freezing of gait. On the other hand, a recent study noted gait changes just prior to freezing and concluded that dyscontrol of the cadence of walking contributes to freezing. To address this question, we compared the gait of PD subjects with freezing of gait to PD subjects without freezing of gait. Given the potential importance of the dyscontrol of the cadence of walking in freezing, we focused on two aspects of gait dynamics: the average stride time (the inverse of cadence, a measure of the walking pace or rate) and the variability of the stride time (a measure of "dyscontrol," arrhythmicity and unsteadiness). We found that although the average stride time was similar in subjects with and without freezing, stride-to-stride variability was markedly increased among PD subjects with freezing of gait compared to those without freezing of gait, both while "on" (P<0.020) and "off" (P<0.002) anti-parkinsonian medications. Further, we found that increased gait variability was not related to other measures of motor control (while off medications) and levodopa apparently reduced gait variability, both in subjects with and without freezing. These results suggest that a paradigm shift should take place in our view of freezing of gait. PD subjects with freezing of gait have a continuous gait disturbance: the ability to regulate the stride-to-stride variations in gait timing and maintain a stable walking rhythm is markedly impaired in subjects with freezing of gait. In addition, these findings suggest that the inability to control cadence might play an important role in this debilitating phenomenon and highlight the key role of dopamine-mediated pathways in the stride-to-stride regulation of walking.
BACKGROUND: Neurologic abnormalities affecting gait occur early in several types of non-Alzheimer's dementias, but their value in predicting the development of dementia is uncertain. METHODS: We analyzed the relation between neurologic gait status at base line and the development of dementia in a prospective study involving 422 subjects older than 75 years of age who lived in the community and did not have dementia at base line. Cox proportional-hazards regression analysis was used to calculate hazard ratios with adjustment for potential confounding demographic, medical, and cognitive variables. RESULTS: At enrollment, 85 subjects had neurologic gait abnormalities of the following types: unsteady gait (in 31 subjects), frontal gait (in 12 subjects), hemiparetic gait (in 11 subjects), neuropathic gait (in 11 subjects), ataxic gait (in 10 subjects), parkinsonian gait (in 8 subjects), and spastic gait (in 2 subjects). During follow-up (median duration, 6.6 years), there were 125 newly diagnosed cases of dementia, 70 of them cases of Alzheimer's disease and 55 cases of non-Alzheimer's dementia (47 of which involved vascular dementia and 8 of which involved other types of dementia). Subjects with neurologic gait abnormalities had a greater risk of development of dementia (hazard ratio, 1.96 [95 percent confidence interval, 1.30 to 2.96]). These subjects had an increased risk of non-Alzheimer's dementia (hazard ratio, 3.51 [95 percent confidence interval, 1.98 to 6.24]), but not of Alzheimer's dementia (hazard ratio, 1.07 [95 percent confidence interval, 0.57 to 2.02]). Of non-Alzheimer's dementias, abnormal gait predicted the development of vascular dementia (hazard ratio, 3.46 [95 percent confidence interval, 1.86 to 6.42]). Among the types of abnormal gait, unsteady gait predicted vascular dementia (hazard ratio, 2.61), as did frontal gait (hazard ratio, 4.32) and hemiparetic gait (hazard ratio, 13.13). CONCLUSIONS: The presence of neurologic gait abnormalities in elderly persons without dementia at base line is a significant predictor of the risk of development of dementia, especially non-Alzheimer's dementia.