Ankle-foot orthoses improve walking but do not reduce dual-task costs after stroke.

BACKGROUND: Cognitive-motor interference, as measured by dual-task walking (performing a mental task while walking), affects many clinical populations. Ankle-foot orthoses (AFOs) are lower-leg splints prescribed to provide stability to the foot and ankle, as well as prevent foot drop, a gait deficit common after stroke. AFO use has been shown to improve gait parameters such as speed and step time, which are often negatively impacted by dual-task walking. OBJECTIVES: Our objective was to establish whether AFOs could protect against cognitive-motor interference, as measured by dual-task walking, following post-stroke hemiplegia. METHODS: A total of 21 individuals with post-stroke hemiplegia that use an AFO completed a dual-task walking paradigm in the form of a 2 (walking with vs. without a concurrent cognitive task) by 2 (walking with vs. without an AFO) repeated-measures design. Changes to both motor and cognitive performance were analyzed. RESULTS: The results suggest that the use of an AFO improves gait overall in both single- and dual-task walking, particularly with respect to stride regularity, but there were no interactions to suggest that AFOs reduce the cognitive-motor dual-task costs themselves. A lack of differences in cognitive performance during dual-task walking with and without the AFO suggests that the AFO's benefit to motor performance cannot be attributed to task prioritization. CONCLUSIONS: These data support the use of AFOs to improve certain gait parameters for post-stroke hemiplegia, but AFOs do not appear to protect against cognitive-motor interference during dual-task walking. Future research should pursue alternate therapeutics for ameliorating task-specific declines under cognitively demanding circumstances.

Experience of People With Disabilities in Haiti Before and After the 2010 Earthquake: WHODAS 2.0 Documentation.

OBJECTIVE: To describe the functioning and participation of people with disabilities seen in Haiti Team Canada Healing Hands clinics before and after the 2010 earthquake. DESIGN: Cross-sectional survey. SETTING: Rehabilitation clinics. PARTICIPANTS: A convenience sample of individuals attending Team Canada Healing Hands clinics (N=194): individuals who completed the survey before the 2010 earthquake (n=72) and individuals who completed the survey after the 2010 earthquake (n=122). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). RESULTS: Overall WHODAS 2.0 scores before and after the 2010 earthquake were in the top 10th percentile of population normative data, where higher scores reflect greater disability. A median increase (6.6 points) in disability was reported after the earthquake (Mann-Whitney U, P=.055). There was a significant increase (Mann-Whitney U, P<.001) in WHODAS 2.0 scores related to mobility (18.8 points), life activities (30 points), and participation (16.7 points) domains after the earthquake. CONCLUSIONS: Persons in Haiti with a disability attending Team Canada Healing Hands clinics reported a low level of functioning. The increase in WHODAS 2.0 scores related to mobility, life activities, and participation domains suggests that the 2010 earthquake had a negative impact on functioning of this population and provides additional information on the responsiveness of the WHODAS 2.0 in limited resource settings. Future work can include using WHODAS 2.0 to monitor the impact of rehabilitation service and advocacy initiatives in Haiti and similar locations.

Gait variability and regularity of people with transtibial amputations.

Gait temporal-spatial variability and step regularity as measured by trunk accelerometry, measures relevant to fall risk and mobility, have not been well studied in individuals with lower-limb amputations. The study objective was to explore the differences in gait variability and regularity between individuals with unilateral transtibial amputations due to vascular (VAS) or nonvascular (NVAS) reasons and fall history over the past year. Of the 34 individuals with trans-tibial amputations who participated, 72% of the 18 individuals with VAS and 50% of the 16 individuals with NVAS had experienced at least one fall in the past year. The incidence of falls was not significantly different between groups. Variability measures included the coefficient of variation (CV) in swing time and step length obtained from an electronic walkway. Regularity measures included anteroposterior, medial-lateral and vertical step regularity obtained from trunk accelerations. When controlling for velocity, balance confidence and time since amputation, there were no significant differences in gait variability or regularity measures between individuals with VAS and NVAS. In comparing fallers to nonfallers, no significant differences were found in gait variability or regularity measures when controlling for velocity and balance confidence. Vertical step regularity (p=0.026) was found to be the only significant parameter related to fall history, while it only had poor to fair discriminatory ability related to fall history. There is some indication that individuals who have experienced a fall may walk with decreased regularity and this should be explored in future studies.

Ambulation of people with lower-limb amputations: relationship between capacity and performance measures.

OBJECTIVES: To examine the relationship between measures of ambulation capacity obtained in a clinical setting and measures of ambulation performance in the community, and to explore what demographic and clinical variables influence ambulation performance in people with lower-limb amputations. DESIGN: A cross-sectional, correlational and descriptive study. SETTING: Rehabilitation center and participants' homes and community environments. PARTICIPANTS: Community-dwelling people (N=52) with lower-limb amputations at the unilateral transfemoral (n=16), unilateral transtibial (n=30), and bilateral transtibial (n=6) levels. All had been fit with prostheses for over 1 year. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures of ambulation capacity were the Locomotor Capabilities Index version 5, the 2-Minute Walk Test (2MWT), and the Timed Up and Go Test. Measures of ambulation performance included a commercially available step activity monitor (SAM; steps per day, minutes active per day, peak activity index) and self-reported performance with the Activity Restriction subscales of the Trinity Amputation and Prosthesis Experience Scales (TAPES). RESULTS: Most relationships among capacity and performance measures were in the moderate to high range (Spearman correlation coefficients, rho=.41-.78, P<.05). The highest correlation coefficient was between the 2MWT and SAM peak activity index (rho=.78, P=.000). A multivariate analysis found the 2MWT was significantly related to increased performance as measured by SAM mean steps per day (P=.026) and TAPES (P=.016). Depressive symptoms were also a significant predictor (P=.003) of decreased performance (TAPES). CONCLUSIONS: The 2MWT, a measure of ambulation capacity, correlates well with most SAM measures of ambulation performance. Exploratory regression analysis indicated that the 2MWT is related to ambulation performance, while depression is only related to self-reported performance.

Effect of a shock-absorbing pylon on transmission of heel strike forces during the gait of people with unilateral trans-tibial amputations: a pilot study.

The primary objective was to test the hypothesis that walking with a shock-absorbing pylon (SAP) decreases the peak magnitude and frequency content of the heel-strike-initiated shock wave transmitted to the stump. The secondary hypotheses were that walking with a SAP decreases the heel-strike transient force between the ground and the foot and increases function as measured by walking velocity and subjective assessments. Seven people with unilateral trans-tibial amputations walked at self-selected speeds without and with a SAP. As the primary outcome measure, accelerometers were used mounted proximally and distally along the prosthetic pylon to measure the transmitted shock wave. Secondary measures included ground reaction forces from a force plate, a ten-minute walking test to determine walking speed and a questionnaire to evaluate gait function and subjective preference. The SAP provided no significant shock absorption as indicated by either the mean peak proximal accelerations of 3.19 g and 2.82 g (p = 0.28) without and with the SAP respectively or the mean difference between the peak proximal and distal accelerometers, 0.16 g and 0.19 g (p = 0.58). No significant change in the frequency content was found. Variances were high. There were no significant differences noted in the secondary measures. Although this study failed to identify any statistically significant effects due to the SAP, the magnitude and variance of the data will permit an accurate estimation of the appropriate sample size for future studies required to determine the efficacy of SAPs.