Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case-control study.

BACKGROUND: Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups. METHODS: Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables. RESULTS: There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking. CONCLUSIONS: Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.

Effect of progressive bridging exercise on weight-bearing during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke: A randomised controlled trial.

OBJECTIVE: To examine the effect of a progressive bridging exercise on force, time, and pressure during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke. DESIGN: A single-blinded randomised controlled trial. SETTING: Hospital. PARTICIPANTS: Forty-eight individuals with acute ischemic stroke, not at brainstem and cerebellum, randomly allocated to the intervention (n = 24) and control (n = 24) groups. Five participants dropped out during the 2-month follow-up, but they were in the intention-to-treat analysis. INTERVENTIONS: The intervention group undertook a 45-min conventional physiotherapy and a 30-min progressive bridging exercise. The control group received only the conventional exercise. MAIN MEASURES: Peak vertical ground reaction force, time to peak force, peak foot pressure, and regional peak foot pressure during the extension phase of sit-to-stand, and sitting-to-standing item of the Motor Assessment Scale were assessed before training, after 4-week training, and 2-month follow-up. RESULTS: The intervention group showed significantly (p < 0.001) less difference in peak vertical ground reaction force between feet during the extension phase of sit-to-stand than the control after 4-week training (mean ± standard deviation; intervention, 5.38 ± 3.99; control, 17.1 ± 10.3) and 2-month follow-up (intervention, 6.79 ± 3.84; control, 17.5 ± 9.89), and demonstrated significantly (p < 0.001) higher score in sit-to-stand than the control after training [mean (interquartile range); intervention, 5 (2-5); control, 2 (1-2)] and follow-up [intervention, 2 (2-5); control, 2 (1-2)]. Both groups demonstrated peak foot pressure on the medial and lateral heels, metatarsals, and hallux regions. CONCLUSION: Progressive bridging exercise improved symmetrical weight bearing during the extension phase of sit-to-stand, consequently enhanced sit-to-stand ability in individuals with stroke.

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial.

OBJECTIVE: To determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke. MATERIALS AND METHODS: Twenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up. RESULTS: The primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS. CONCLUSION: The combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.

Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis.

OBJECTIVES: This study aimed to investigate the effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis (PF). METHODS: A single group pre- and post-test design was conducted for this study in 20 patients with PF. They had the self home-based stretching program of calf muscle for 3 weeks. They were assessed for the multi-segmental foot motion (degree) and clinical outcomes which included the plantar fascia pain/disability scale (PFPS) (score), muscle length (degree) of gastrocnemius and soleus, and muscle strength (kg) of ankle dorsiflexors, plantarflexors, invertors, evertors, great toe flexors, and lesser toe flexors. RESULTS: There were no significant differences (p>0.05) in multi-segmental foot motion and muscle length after exercise. Significant improvements (p<0.05) were found in PFPS and muscle strength of ankle plantarflexors, invertors, evertors, great toe flexors, and lesser toe flexors after exercise. CONCLUSIONS: A home-based stretching exercise was an effective program for reducing pain, enhancing muscle strength for both extrinsic and intrinsic foot muscles in patients with PF.

Clinimetric properties of the one-leg sit-to-stand test in examining unilateral lower limb muscle strength among young adults.

BACKGROUND: One-leg sit-to-stand (one-leg STS) test is a new clinical test developed to measure the unilateral lower limb (LE) muscle strength among young adults. This study examined the test-retest reliability and the criterion-concurrent validity of the one-leg STS. METHODS: Forty young adults (mean age ± SD, 28.07 ± 5.39 years) participated in the study. The one-leg STS test was administered in two separate assessment sessions to examine test-retest reliability. Two-leg STS test was administered and the performance time was measured. The concentric peak strength of hip flexors/extensors, knee flexors/extensors and ankle dorsi-flexors/plantar-flexors were determined using an isokinetic dynamometer. An intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of one-leg STS test. The criterion validity of the one-leg STS test was evaluated against the performance of the two-leg STS test using an independent sample t test. The concurrent validity of the one-leg STS test was evaluated by investigating the relationships between STS performance time and LE muscle strength using Pearson correlation coefficients. RESULTS:  The reliability analysis showed that one-leg STS performance time had excellent test-retest reliability (ICC3,1  = 0.960, P < .001). Also, the one-leg STS performance time was not different between the first and second sessions, t (39) = 0.672, P = .506. The performance time of the one-leg STS test was significantly greater than the two-leg STS test (t (39) = 20.63, P < .001). The performance time of the one-leg STS test significantly correlated with the concentric peak strength of all LE muscles (P < .05). CONCLUSIONS: The one-leg STS test demonstrated excellent reliability and criterion-concurrent validity against the two-leg STS and the LE muscle strength. The one-leg STS test was simple to administer and could be beneficial for the assessment of unilateral LE muscle strength of young adults in clinical settings.

Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study.

BACKGROUND: Facet joint is a potential structure to be the source of chronic low back pain (LBP) affecting lumbar motion, pain, and disability. Other than the recommended treatment of lumbar stabilization exercise (LSE), several manual procedures including muscle energy technique (MET) are commonly used in physical therapy clinic. However, little evidences of the effects of MET have been reported. OBJECTIVE: This study aimed to compare the immediate effects of MET and LSE in patients with chronic LBP with suspected facet joint origin. METHODS: Twenty-one patients with low back pain were recruited and randomly assigned to receive treatment either MET or LSE. The outcomes were kinematic changes, pain intensity, and disability level. Lumbar active range of motion (ROM) of flexion, extension, left and right lateral flexion, and left and right rotation were evaluated using the three-dimension motion analysis system at baseline and immediately after treatment. Pain intensity was evaluated using visual analogue scale (VAS) at baseline, immediately after, and two days after treatment. Thai version of the modified Oswestry disability questionnaire (ODQ) was utilized at baseline and two days after treatment. The mixed model analysis of variance was used to analyze all outcomes. RESULTS: The results showed that all outcomes were not different between groups after treatments. Although there were statistically significant improvements after the treatments when collapsing the groups, the minimal clinically important change was found only for pain but not for lumbar movements and disabilities scores. CONCLUSION: The effect of MET and LSE alone in single session might not be intensive enough to improve movements and decrease disability in patients with chronic LBP with suspected facet joint origin.

Effect of spinal tap test on the performance of sit-to-stand, walking, and turning in patients with idiopathic normal pressure hydrocephalus.

The aim of the study was to investigate the effect of the spinal tap test on sit-to-stand (STS), walking, and turning and to determine the relationship among the outcome measures of STS, walking, and turning in patients with iNPH. Twenty-seven patients with clinical symptoms of iNPH were objectively examined for STS, walking, and turning by the Force Distribution Measurement (FDM) platform connected with a video camera. Assessments were performed at before and 24 hours after spinal tap. Motor abilities were assessed by the STS time, time of walking over 3 meters, and time and number of steps when turning over 180 degrees. Significant improvements were found in the STS time (p = 0.046), walking time (p = 0.048), and turning step (p = 0.001). In addition, turning time was improved but not statistically significant (p = 0.064). Significant relationships were found among all outcome measures (p < 0.001). The relationship among these outcome measures indicated that the individuals had similar ability levels to perform different activities. This may serve as a new choice of outcome measures to evaluate the effect of intervention in different severity levels of patients with iNPH.

Ground Reaction Forces of the Lead and Trail Limbs when Stepping Over an Obstacle.

BACKGROUND: Precise force generation and absorption during stepping over different obstacles need to be quantified for task accomplishment. This study aimed to quantify how the lead limb (LL) and trail limb (TL) generate and absorb forces while stepping over obstacle of various heights. MATERIAL AND METHODS: Thirteen healthy young women participated in the study. Force data were collected from 2 force plates when participants stepped over obstacles. Two limbs (right LL and left TL) and 4 conditions of stepping (no obstacle, stepping over 5 cm, 20 cm, and 30 cm obstacle heights) were tested for main effect and interaction effect by 2-way ANOVA. Paired t-test and 1-way repeated-measure ANOVA were used to compare differences of variables between limbs and among stepping conditions, respectively. The main effects on the limb were found in first peak vertical force, minimum vertical force, propulsive peak force, and propulsive impulse. RESULTS: Significant main effects of condition were found in time to minimum force, time to the second peak force, time to propulsive peak force, first peak vertical force, braking peak force, propulsive peak force, vertical impulse, braking impulse, and propulsive impulse. Interaction effects of limb and condition were found in first peak vertical force, propulsive peak force, braking impulse, and propulsive impulse. CONCLUSIONS: Adaptations of force generation in the LL and TL were found to involve adaptability to altered external environment during stepping in healthy young adults.

Plantar Pressure Distribution Pattern during Mid-Stance Phase of the Gait in Patients with Chronic Non-Specific Low Back Pain.

OBJECTIVE: To examine the characteristics of the plantar pressure distribution patterns during mid-stance phase of the gait cycle in subjects with chronic non-specific low back pain and asymptomatic subjects. MATERIAL AND METHOD: Twenty-three males and 17 females with chronic non-specific low back pain and age- and gender-matched asymptomatic subjects walked barefoot along a gait mat at comfortable speedfor three trials. The left and right plantar pressure distributions were recorded during mid-stance phase and divided into 12 areas. Descriptive statistics including mean and standard deviation of demographic data and plantar pressure were calculated, and plantar pressure distribution patterns were described. RESULTS: Mean and standard deviation of numeric pain rating scale of chronic non-specific low back pain group were 4.04±1.58. The average mean peak pressure of both chronic non-specific low back pain and asymptomatic subjects located at the fifth area (lateral aspect offorefoot) in both feet. However the modes of the peak pressure of subjects with chronic non-specific low back pain were in the different areas in the left and right feet. The distribution patterns of the average mean peak pressure were not the same in chronic non-specific low back pain and asymptomatic subjects. This altered foot contact in the subjects with chronic non-specific low back pain may be used to avoid pain or to compensate for limited mobility of the lower limbs at pre-swing phase. CONCLUSION: At mid-stance phase of walking, the pressures on the plantar surface were unequally distributed in subjects with chronic non-specific low back pain.

Effects of Foot Muscles Training on Plantar Pressure Distribution during Gait, Foot Muscle Strength, and Foot Function in Persons with Flexible Flatfoot.

OBJECTIVE: To investigate the effects of a foot-muscle trainingprogram on plantarpressure distribution, foot muscle strength, and foot function in persons with flexible flatfoot. MATERIAL AND METHOD: Participants received foot-muscle training 3 times weekly, over 8 weeks. Training consisted of gastrosolues muscle stretching and strengthening the muscles around the ankle and the intrinsic muscles. The contact area andpeak pressure under the hallux, first metatarsal, and medial midfoot were assessed by the Force Distribution Measurement Plaform while walking. Strength ofthe tibialis posterior and peroneus longus muscles were assessed by handheld dynamometer. Foot function regarding difficulty in activities of daily living was assessed. All measures were assessed at pre-training, intermediate-training, and post-training. Friedman ANOVA was used for testing mean differences among the variables. RESULTS: Five participants with flexible flatfoot were recruited in the study. Results demonstrated significant increases in tibialis posterior (p = 0.018) and peroneus longus muscles strength (p = 0.007), and significant decrease infootfunction score (p = 0.021). In addition, no significant difference in contact area and peak pressure was observed among testing periods. CONCLUSION: Foot-muscle strength and foot function in persons with flexible flatfoot can be improved significantly after receiving foot-muscle training.

Improvement of Gait Symmetry in Patients with Stroke by Motor Imagery.

OBJECTIVE: To investigate effect of gait training with motor imagery (MI) on gait symmetry and self-efficacy offalling in stroke patients. MATERIAL AND METHOD: Fourteen stroke patients were categorized in the MI (n = 7) and control (n = 7) groups. They were matched by age range, stroke type, paretic side, time since stroke, and severity. All participants received physical therapy and only the MI group received additional MI training. Both groups were trained for 12 sessions over 1 month. Outcome measurements comprised gait symmetry detecting by theforce distribution measurement platform and self-efficacy offalling testing by the Fall Efficacy Scale-International (FES-I). Both groups were assessed three times:.pre-, intermediate- and post-trainings. Comparisons of all variables between and within groups were tested by Mann-Whitney U test and Friedman ANOVA test, respectively. RESULTS: No significant difference was observed of gait symmetry between MI and control groups. Within group comparison, tendencies of improvement were found in step length and step time symmetry for the MI group. Significant improvements in step length symmetry and FES-I score were found among assessments for the MI group (p<0.05). CONCLUSION: Gait training with MI enhanced ability of step length symmetry and decreased fear offalling in patients with stroke.

Cross-Cultural Adaptation of the Compendium of Physical Activity: Thai Translation and Content Validity.

OBJECTIVE: To translate the compendium physical activity (compendium) proposed by Ainsworth to Thai and to validate the Thai translated version. MATERIAL AND METHOD: Five steps of cross-cultural adaption were conducted as follows: (1) forward translation, (2) group review, (3) backward translation, (4) group review and final decision and (5) a pilot study. Eight hundred and twenty-one activities ofthe compendium were translated to Thai by two independents translators. Thai translated version was considered by 23 persons who have studied physical activity for at leastfive years. Backward translation was carried out by two bilingual translators. The research team completed the final Thai translation by comparing original and translated versions. For pilot study the Thai translated version was validated by 22 allied health persons. Data was analyzed by multi-rater agreement (Fleiss's kappa) and qualitative analysis. RESULTS: For translations and group review, recommendations included; (a) changing to lay language with the same meaning, (b) converting the U.S. customary unit to the metric unit, and (c) using consistent language. More than 80% of 22 persons accepted the Thai translation and the Kappa agreement rangedfrom 0.187 to 0.694. Some activities demonstratedpoor multi-rater agreement and required additional definitions. CONCLUSION: Thai translated compendium physical activity was constructed to reduce the language barrier and promote physical activity in Thailand. The poor to moderate agreement of each major heading of translation may partly be due to Western culture. Many activities in the compendium were assembled but they were not recognized by Thais. Hence, Thai compendium physical activity should to be developed in afuture study.

Walking and stair climbing abilities in individuals after chronic stroke with and without mental health problem.

OBJECTIVE: To compare muscle strength, balance, walking and stair climbing abilities among individuals after chronic stroke with or without mental health problems; to describe their physiological response after stress stimulation. MATERIAL AND METHOD: Subjects who had their first stroke more than one year ago were classified for mental health problems according to the Depression Anxiety Stress Scale-21. Lower extremity muscle strength of the quadriceps and plantar flexors, was measured by dynamometer Balance and walking performance was measured by the Berg Balance Scale (BBS), 10-m walk test and timing of stair climbing. Community participation and spiritual well-being were measured. The physiological response of stress stimulation was assessed by the long stress test protocol of the biofeedback device. RESULTS: Forty-five subjects with chronic stroke aged 40-80 years were grouped by with (n = 25) and without mental health problems (n = 20). Significant differences were found in quadriceps muscle strength, BBS, walking and stair climbing speed, community participation and spiritual well-being between two groups. In the stress stimulus phase, the electromyography and heart rate variability demonstrated significant difference between those with and without stress. CONCLUSION: Individuals with chronic stroke with mental health problems demonstrated decreased quadriceps muscle strength, balance and locomotor performances.

Reach-to-grasp training in individuals with chronic stroke augmented by low-frequency repetitive transcranial magnetic stimulation.

OBJECTIVE: The present study investigated the immediate effects of low frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with reach-to-grasp (RTG) training of the paretic hand in individuals with chronic stroke. MATERIAL AND METHOD: Fourteen participants were randomly assigned to receive LF-rTMS or sham stimulation conditions. All participants underwent RTG training after the stimulation. Corticospinal excitability (CE) of the non-lesioned hemisphere, the total time of the wolf motor function test (WMFT) for dexterity tasks, maximum aperture, and movement time of RTG actions were evaluated at baseline, after the stimulation, and after RTG training. RESULTS: Significant differences between interaction (group x time) were found in the total time of WMFT The CE of non-lesioned hemisphere diminished after LF-rTMS and showed moderate correlation with the reduction in time of RTG actions after the stimulation. The total time of WMFT and RTG actions reduced after motor training only in the LF-rTMS group. No change was observed in maximum aperture in either group. CONCLUSION: The application of LF-rTMS combined with RTG training enhanced the training effect as evidenced by faster movement for the dexterity tasks of the paretic hand than RTG training alone. The findings suggested the benefit of LF-rTMS for enhancing the training effects in stroke rehabilitation.

Association of scoliosis with lower extremity alignments, muscle strengths, and foot characteristics and their alterations in adolescent idiopathic scoliosis.

BACKGROUND: The association between changes occurring in the spine and lower body parts is not well understood in adolescent idiopathic scoliosis (AIS). OBJECTIVES: The first aim of the study was to investigate the association of scoliosis with lower extremity (LE) alignments, foot characteristics, and muscle strengths in adolescents. Secondly, comparisons of the data among AIS with single and double curves and control groups were determined. METHODS: Thirty-one participants were recruited and classified into 3 groups; AIS with a single curve (n= 7), AIS with double curves (n= 14), and controls (n= 10). Association of the presence of scoliosis with LE alignments (Q and TC angles), LE muscle strengths (hip, knee, and ankle), and foot characteristics (arch indexes) were examined using the point biserial correlation, and the data among three groups were compared using the ANOVA. RESULTS: Scoliosis was associated with Q angle, arch indexes, and all LE muscle strengths except for hip extensors and ankle plantar flexors strengths. Comparisons among the three groups showed significant increases in LE alignments and foot characteristics in AIS. Almost all LE muscle strengths decreased in AIS, especially for the single curve group. CONCLUSIONS: Apart from spinal deformity, the AIS has changed in LE alignments, muscle strengths, and foot characteristics. Therapists should consider these associations and alterations for designing proper management.

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus.

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen's d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.

Effectiveness of Motor Imagery Combined with Structured Progressive Circuit Class Training on Functional Mobility in Post-Stroke Individuals: A Randomized Controlled Trial.

OBJECTIVE: To compare the effect of motor imagery combined with structured progressive circuit class therapy vs health education combined with structured progressive circuit class therapy on dynamic balance, endurance, and functional mobility in post-stroke individuals. DESIGN: Randomized controlled trial. METHODS: A total of 40 post-stroke individuals were randomly assigned to experimental and control groups. The experimental group was trained using motor imagery combined with structured progressive circuit class therapy, while the control group received health education combined with structured progressive circuit class therapy, 3 times a week for 4 weeks with an overall of 12 sessions. Outcomes included the step test for affected and unaffected limbs, the 6-Minute Walk Test, and the Timed Up and Go test. Assessments were performed at baseline, 2 weeks, and 4 weeks after the intervention Results: There were significant effects (p < 0.05) of: group on the step test for unaffected limb; of time on all outcomes; and of their interaction effect on the step test for affected limb, 6-Minute Walk Test, and Timed Up and Go test. Inter-group comparison showed significant differences (p < 0.05) in the step test for unaffected limb at 2 weeks after the intervention. At 4 weeks after the intervention, significant differences (p < 0.05) were found in the step test for affected and unaffected limbs and in the Timed Up and Go test. CONCLUSION: Motor imagery combined with structured progressive circuit class therapy was more effective on the step test, 6-Minute Walk Test, and Timed Up and Go test than training with structured progressive circuit class therapy alone. This suggest that that motor imagery should be incorporated into training programmes for restoring dynamic balance, endurance, and functional mobility in post-stroke individuals.

The effect of a home-based stretching exercise on the ground reaction force generation and absorption during walking in individuals with plantar fasciitis.

OBJECTIVES: This study aimed to investigate effect of a home-based stretching exercise program in individuals with plantar fasciitis (PF) and to compare its effect on ground reaction force (GRF)-time variables between mild, moderate, and severe pain subgroups and between before and after in each subgroup. DESIGN: A single cohort with pre-and post-test. INTERVENTIONS: Twenty individuals with PF received 3 weeks of home-based stretching exercise for calf and plantar fascia. MAIN OUTCOME MEASURES: GRF-time variables included force and time at; first peak (F1 and TF1), valley (F2 and TF2), second peak (F3 and TF3) in vertical, breaking (F4 and TF4) and propulsive (F5 and TF5) forces, first peak (F6 and TF6) and second peak lateral (F7 and TF7) forces. Additionally, worst pain was assessed at before and after exercise. RESULTS: Significant reductions were seen in F2, TF2, TF3, TF5 and worst pain after exercise (P < 0.05) in individuals with PF. No differences were seen between three subgroups. For within subgroup analysis, only mild subgroup showed significant changes in F2, TF2, F4, TF6, and TF7 after exercise (P < 0.05). CONCLUSION: A home-based stretching exercise was effective in reducing pain and some GRF-time variables, with the most noticeable response seen in mild subgroup.

Gait symmetrical indexes and their relationships to muscle tone, lower extremity function, and postural balance in mild to moderate stroke.

OBJECTIVE: To investigate asymmetrical gait characteristics and degree of associations between gait symmetrical indexes and clinical measures in a stroke population. MATERIAL AND METHOD: Thirty patients with stroke participated in the present study. Clinical measures included muscle tone of affected hip adductors (HA), hip extensors (HE), knee extensors (KE), ankle plantar flexors (AP) and ankle invertors (AI), lower extremity function and postural balance. Symmetrical indexes of gait biomechanics included braking peak force (Y1), propulsive peak force (Y2), first peak vertical force (Z1) and second peak vertical force (Z2), step length, single support time (SST), step time, stance time and swing time were determined. RESULTS: The symmetrical index of force was significantly related with muscle tone and lower extremity function. Temporospatial variables significantly related to muscle tone and lower extremity function, but not to postural balance. CONCLUSION: Muscle tone and lower extremity function were important for walking efficiency as the presented relationships with symmetrical gait characteristic in patients with a stroke.

Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients.

Action observation (AO) has been proved to be of benefit in several neurological conditions, but no study has previously been conducted in idiopathic normal pressure hydrocephalus (iNPH). OBJECTIVE: This study aimed to investigate the feasibility of AO in iNPH patients. METHODS: A single-group pretest-posttest design was conducted in twenty-seven iNPH patients. Gait and mobility parameters were assessed using the 2D gait measurement in the timed up and go (TUG) test for two trials before and after immediate AO training. The outcomes included step length and time, stride length and time, cadence, gait speed, sit-to-stand time, 3-m walking time, turning time and step, and TUG. In addition, early step length and time were measured. AO consisted of 7.5 min of watching gait videos demonstrated by a healthy older person. Parameters were measured twice for the baseline to determine reproducibility using the intraclass correlation coefficient (ICC3,1). Data between before and after immediately applying AO were compared using the paired t-test. RESULTS: All outcomes showed moderate to excellent test-retest reliability (ICC3,1=0.51 0.99, p<0.05), except for the step time (ICC3,1=0.19, p=0.302), which showed poor reliability. There were significant improvements (p<0.05) in step time, early step time, gait speed, sit-to-stand time, and turning time after applying AO. Yet, the rest of the outcomes showed no significant change. CONCLUSIONS: A single session of AO is feasible to provide benefits for gait and mobility parameters. Therapists may modify this method in the training program to improve gait and mobility performances for iNPH patients.

A observação de ação (OA) teve benefícios comprovados em diversas condições neurológicas, mas nenhum estudo foi conduzido anteriormente em Hidrocefalia de Pressão Normal idiopática (HPNi). OBJETIVO: O presente estudo teve como objetivo investigar a viabilidade da OA em pacientes com HPNi. MÉTODOS: Um projeto de pré-teste e pós-teste de grupo único foi realizado em 27 pacientes com HPNi. Parâmetros de marcha e mobilidade foram avaliados por meio de parâmetros 2D para a medida da marcha com o teste timed up and go (TUG) com duas tentativas antes e imediatamente depois do OA. Os resultados incluíram comprimento e tempo do passo, comprimento e tempo da passada, cadência, velocidade da marcha, tempo para sentar-e-levantar, tempo de caminhada de 3 metros, tempo de virada e passo, e tempo do teste (TUG). Além disso, o comprimento do passo inicial e o tempo da etapa inicial foram medidos. A OA consistia em assistir 7,5 minutos de vídeos de marcha demonstrados por um idoso saudável. Os parâmetros foram medidos duas vezes para a linha de base para determinar a reprodutibilidade usando o coeficiente de correlação intraclasse (CCI3,1). Os dados entre antes e depois da aplicação imediata de OA foram comparados com o teste t pareado. RESULTADOS: Todos os resultados mostraram confiabilidade teste-reteste moderada a excelente (CCI3,1=0,51 0,99, p<0,05), exceto para o tempo do passo (CCI3,1=0,19, p=0,302), que apresentou confiabilidade pobre. Houve melhorias significativas (p<0,05) no tempo do passo, tempo do passo inicial, velocidade da marcha, tempo sentar-e-levantar e tempo de virar após a aplicação de OA. Os demais resultados não mostraram nenhuma mudança significativa. CONCLUSÕES: Uma única sessão de aplicação de OA é viável para proporcionar benefícios aos parâmetros de marcha e mobilidade. Os terapeutas podem modificar esse método no programa de treinamento para obter desempenho de marcha e mobilidade para pacientes com HPNi.