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Vibration sensation is related to motor function. However, it is unclear which vibration frequencies are associated with motor function. Therefore, in this cross-sectional study, we investigated whether a specific frequency of vibration sensation could explain motor functions. Thirty-two community-dwelling Japanese healthy older adults aged 70 years or older participated in the present study. Grip strength, one-leg standing time, and 10-m walking time were evaluated as indicators of motor function. Vibratory (40, 128, and 256 Hz) and tactile sensory tests were examined as sensory functions. Grip strength per body weight was significantly correlated with sex, body mass index, falls efficacy scale, vibration sensation with 40 and 128 Hz, and 10-m walking time (P < 0.05). Furthermore, one-leg standing time showed a correlation between vibration sensation (128 and 256 Hz) and fall history (P < 0.05). However, 10-m walking time was significantly correlated with only the grip strength to body weight ratio. Multiple regression analysis showed that vibration sensation with 128 Hz (β = 0.427) and sex (β = -0.335) (P < 0.05) were significant independent variables associated with grip strength to body weight ratio. Vibration sensation with 256 Hz (β = 0.465) and age (β = -0.343) (P < 0.05) were significant independent variable associated with one-leg standing time. No significant variables were identified for the 10-m walking time. Vibration sensation associated with motor function shows specific frequency characteristics in community-dwelling older Japanese adults.
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Objective:To observe any effect of dynamic motor instability training on the balance and postural control of stroke survivors.Methods:Forty stroke survivors with poor balance were randomly divided into a control group and an observation group, each of 20. In addition to routine rehabilitation, the observation group was given 20 minutes of dynamic motor instability training, 5 days a week for 8 weeks, while the control group underwent routine rehabilitation for the same length of time. Before and after the intervention, surface electromyogram of the rectus femoris, biceps femoris, and erector spinae were recorded during perturbation. Activation time and the intensity of the anticipatory and complementary postural adjustments (APAs and CPAs) were also observed. Balance and lower limb motor functioning were assessed using the Berg balance scale (BBS), the Fugl-Meyer lower extremity assessment (FMA-LE), and GaitWatch analysis.Results:After the treatment the average activation time of the rectus femoris, biceps femoris in the affected side and those of the biceps femoris [(-84.31±5.74)s] and erector spinae in the intact side in APAs were all significantly shorter in the observation group than in the control group, while the average activation intensity of the rectus femoris and erector spinae was significantly greater. There was no significant difference in the activation intensity of each muscle group in CPAs after the treatment. After the intervention the average BBS score, FMA-LE score, stride length and walking speed of the observation group all were significantly better than the control group′s averages.Conclusions:Supplementing traditional rehabilitation training with dynamic motor instability training can further improve the posture control of stroke survivors and promote recovery of their balance and walking ability.
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Objective:To explore the ability of training on a three-dimensional motion platform to improve the walking ability and skill in the activities of daily living of hemiplegic stroke survivors.Methods:A total of 70 stroke survivors with hemiplegia were randomly divided into a control group ( n=35) and an intervention group ( n=35). In addition to routine rehabilitation, the control group received 40 minutes of ground balance training, while the intervention group received 40 minutes of training on a three-dimensional motion platform 6 times a week for 4 weeks. Before and after the intervention, step length, speed and frequency were evaluated in both groups using the Gait Watch 3D gait analysis system. Walking ability and ability in the activities of daily living were assessed using the de Morton mobility index (DEMMI) and the modified Barthel index (MBI). Results:Before the treatment, there was no significant difference in average step length, speed or frequency between the two groups. The average standing phase percentage on the affected side, percentage of double support period, DEMMI score, and MBI score also were not significantly different. After the treatment those indicators had improved significantly in both groups. The intervention group′s averages were then all significantly better than those of the control group.Conclusions:Three-dimensional motion platform training can improve the walking ability and skill in the activities of daily living of hemiplegic stroke survivors.
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Objective：This study aimed to clarify the objective criteria for assessing walking independence using cane in patients with stroke in the convalescent rehabilitation ward.Methods：Participants were in-patients with hemiparetic stroke who could walk with a cane, and they were categorized into the independent (ID) and supervised (SV) walking groups. Stroke impairment assessment set-motor for lower extremity (SIAS-LE), trunk control test (TCT), Berg balance scale (BBS), 10-m walking speed (m/s), and functional independence measure-cognitive (FIM-C) were assessed. ID and SV used the scores at the time of independent walking and at the discharge time, respectively. Additionally, falls after independence were investigated. Statistical analysis was performed using univariate analysis and decision tree analysis.Results：In total, 148 patients (ID：n=101, 68±13 years, SV：n=47, 79±12) were included. Significant differences were observed in walking speed, TCT score, BBS score, and FIM-C score between the groups. Moreover, walking speed, FIM-C score, and BBS score were selected in the decision tree analysis in this order and divided into five groups namely：1) walking speed ≥ 0.42 and FIM-C ≥ 22 (percentage of independent patients 97％/percentage of fallers 5％), 2.) walking speed ≥ 0.42, FIM-C＜22, and BBS ≥ 50 (100％/0％), 3.) walking speed ≥ 0.42, FIM-C＜22, and BBS＜50 (52％/8％), 4.) walking speed＜0.42, and BBS ≥ 28 (49％/28％), and 5) walking speed＜0.42 and BBS＜28 (0％/0％). The overall percentage of fallers was 8.9％, with group 4 having the highest number of fallers.Conclusion：Walking speed, FIM-C, and BBS, in decreasing order, were involved in walking independence. Patients with low walking speed were more likely to fall. Therefore, careful assessment of walking independence is particularly required.
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Objective:To compare the effect of local vibration and extracorporeal shock wave therapy (ESWT) on triceps spasticity and the walking ability of hemiplegic stroke survivors.Methods:Sixty-nine stroke survivors with hemiplegia were randomly divided into a control group, a vibration group and an ESWT group. The control group received 60 minutes of conventional Bobath rehabilitation treatment and motor relearning from Monday to Saturday for 4 weeks. For the vibration and ESWT groups, 10 minutes of that traditional therapy were replaced by either local vibration or extracorporeal shock wave treatment every Tuesday, Wednesday and Saturday. Before and after the treatment, the three groups were evaluated using the Comprehensive Spasticity Scale (CSS) and in terms of passive joint range of motion (PROM), ankle plantar flexion angle, 10m maximum walking speed, stride frequency, and stride length.Results:After the intervention the average CSS, PROM, and ankle plantar flexion angle were significantly better for all three groups than before the treatment. At that point the ESWT group′s averages were significantly better than those of the vibration group, and the vibration group′s averages were significantly superior to those of the control group. Walking speed, stride frequency and stride length had also improved significantly in all three groups, with those in the vibration and ESWT groups significantly outperforming the control group. There was no significant difference between the vibration and ESWT groups in terms of walking ability.Conclusions:Both local vibration and extracorporeal shock wave therapy improve triceps spasticity and the walking ability of hemiplegic stroke survivors. Shock waves are more effective for improving spasticity, but there is no significant difference between the therapies in terms of improving walking ability.
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Objective:To observe any effect of body-weight-supported treadmill training (BWSTT) combined with functional electrical stimulation (FES) on lower limb motor function and the walking ability of hemiplegic stroke survivors.Methods:Fifty-eight stroke survivors with hemiplegia were randomly divided into an FES group of 19, a BWSTT group of 19 and a combination group of 20. In addition to their early routine rehabilitation therapy, the FES and BWSTT groups were provided with the respective therapies, while the combination group received both. The three groups received 30 minutes of treatment a day, 5 days a week for 8 weeks. The Berg Balance Scale (BBS), the simplified version of the Fugl-Meyer assessment scale for the lower extremities (FMA-LE), the 10-metre walk test (10MWT) and functional ambulation classification (FAC) were used to evaluate the subjects′ balance, lower-limb motor function, walking speed and walking function before and after the 8 weeks of treatment.Results:After the treatment, the average BBS, FMA-LE, 10MWT and FAC scores of all three groups had improved significantly, but the combination group′s averages were then significantly better than those of the other two groups.Conclusions:BWSTT combined with FES can best improve the balance, lower-limb motor functioning and walking of hemiplegic stroke survivors.
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Objective:To explore the effect of Lokomat training on the walking ability of stroke survivors with lower limb spasm.Methods:Eighty stroke survivors with lower limb spasm were randomly divided into an observation group and a control group, each of 40. Their routine rehabilitation treatment included normal limb positioning, passive joint movement, turnover training and inclined bed standing training. In addition, the control group underwent flat-ground walking training, while the observation group was given Lokomat training 3 times a week for 8 weeks. Both groups were evaluated after 4 and 8 weeks of treatment in terms of their walking ability, degree of lower limb spasm, lower limb motor functioning, balance and ability in the activities of daily life.Results:After 4 and 8 weeks the number of patients walking independently was significantly greater in the observation group. Their average stride frequency, step length on the affected side, support phase time and proportion of weight borne on the affected side were all significantly better than the control group′s averages. At both time points significantly more patients of the observation group had normal lower limb muscle tone. The observation group′s average Fugl-Meyer score, Berg Balance Scale score and modified Barthel Index score had improved significantly compared with those before the treatment, and were significantly better than the control group′s averages at the same time point. After 8 weeks of treatment the average walking speed of the observation group was faster than that of the control group.Conclusions:Lokomat training can significantly improve the walking ability of stroke survivors with lower limb spasm in the short term. Longer-term training can consolidate the effect and further improve the walking speed, motor function in the lower limbs, balance and even facility in daily life activities, as well as relieving spasm.
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BACKGROUND: Intraoperative neurophysiological monitoring is popular in spinal surgery. However, a severe iatrogenic spinal cord injury cannot be completely eliminated. Is there a relationship between true positive intraoperative neurophysiological monitoring alert during particular surgical steps and postoperative neurological recovery? This topic is to improve the safety of spinal invasive procedures. OBJECTIVE: To determine the relationship between true positive intraoperative neurophysiological monitoring alert during particular surgical steps and postoperative walking ability. METHODS: A retrospective study of 2 249 patients undergoing intraoperative neurophysiological monitoring in Li Ka Shing Faculty of Medicine, the University of Hong Kong was conducted. Standard patient demographics, diagnosis and operative features and intraoperative neurophysiological monitoring data were collected. There were 10 cases of true positive intraoperative neurophysiological monitoring alert (4 males, 6 females, 14-88 years old), and the average follow-up time was 9.8 years. The patients were divided into two groups based on whether surgical steps triggering intraoperative neurophysiological monitoring alert impact the spinal cord or not. The study was performed in accordance with the ethical requirements of Li Ka Shing Faculty of Medicine, the University of Hong Kong, and the patients and their guardians signed the informed consents. RESULTS AND CONCLUSION: These alerts occurred during decompression (n=3), anterior disc release (n=1), finding the entering point of T3 pedicle (n= 1), screw insertion (n=1), reduction of fracture (n=2), insertion of wire (n= 1), and cement injection (n=1). Among these patients, 100% of spinal cord invasive procedure patients developed incompetence of walking, while 80% (4/5) of spine cord non-invasive patients were capable of walking (P < 0.05). After the alert was triggered, four patients continued with primary program, three patients underwent expanding decompression and three patients gave up surgery. If true positive intraoperative neurophysiological monitoring alert is reported during spinal invasive procedures, there should be a very high chance of postoperative walking disability. If any conditions occur, the surgery needs to be stopped, and instead, remedial measures such as surgery suspension, steroids injection, and additional decompression should be performed immediately.
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PURPOSE: The purpose of this study was to investigate the effects of combined training using proprioceptive neuromuscular facilitation (PNF) patterns and treadmills on the balance and walking ability of stroke patients. METHODS: Twenty-three stroke patients were randomized into a control group (n=11), receiving only treadmill training and an experimental group (n=12) receiving combined training. The use of both PNF exercise and treadmill were implemented in the combined training. Interventions were performed 5 times a week for 6 weeks. Balance ability was measured by a timed up and go (TUG) test. Walking ability was measured by a 10-meter walk test (10MWT) and a 6-minute walk test (6MWT). A paired t-test was used to compare differences between pre- and post-intervention and independent t-tests were used to compare between groups. RESULTS: Changes in TUG, 10MWT, and 6MWT before and after interventions were significantly different for both the experimental group and the control group (p < 0.05). In addition, within-group changes in the TUG, 10MWT, and 6MWT were more effective in the experimental group than in the control group (p < 0.05). CONCLUSION: Combined training using PNF techniques and treadmills may be useful in improving the balance and walking ability of stroke patients.
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Humans , Stroke , WalkingABSTRACT
Objective To explore the prognostic factors in Guillain Barre syndrome (GBS) in children. Methods A total of 125 children with GBS were included and grouped according to their independent walking at two and six months after discharge, and their clinical data were analyzed. Results In 125 children (74 males, 51 females) the average age was 84.49±25.32 months, and 41 were under 6 years old. 102 children had a history of prodromal infections. 32 children had cranial nerve involvement and 35 had autonomic nerve involvement. 12 children need assisted respiration. At 2 and 6 months after discharge, when compared with children who could walk independently, the rates of functional score > 3, cranial nerve involvement, and neuroelectrophysiology as denervation potential were higher in children who could not walk independently, and the differences were statistically significant (P all<0.05). Conclusions The factors that affect the short-term prognosis are denervation potential in neuroelectrophysiology, cranial nerve involvement, and functional score > 3. Early identification of uniqueness in patients and subsequent development of targeted rehabilitation training should be carried out to improve the prognosis.
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Objective To investigate the effect of elispheric motion on balance and walking ability of hemiplegic patients after stroke. Methods From September to December, 2016, 40 hemiplegic patients after stroke were randomly divided into control group (n=20) and ob-servation group (n=20). Both groups received conventional rehabilitation, additionally, the control group received juggling ball training, and the observation group received elispheric motion combined with juggling ball training, 20 minutes a day, six days a week for six weeks. They were assessed with the Fugl-Meyer Assessment-Sensory (FMA-S), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Bal-ance Scale (BBS) and TimedUp and GoTest (TUGT) before and six weeks after training. Results After training, the scores of FMA-S, FMA-LE, BBS significantly increased (t>10.012, P2.129, P10.001, P4.669, P<0.05). Conclusion Elispheric motion can facilitate to improve the balance and walking ability of hemi-plegic patients after stroke.
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Objective To evaluate the effect of robot-assisted gait training on the walking ability of hemiplegic patients.Methods Sixty hemiplegic patients were randomly divided into a control group and a treatment group,each of 30.Both groups were given traditional rehabilitation and drug therapy.The control group was additionally provided with the traditional gait training,while the treatment group additionally received robot-assisted gait training.The gait training lasted 30 minutes a day,5 days per week.Before and after 8 weeks of training,the time parameters,phase parameters,the joint angles of the lower limbs,and the peak ground reaction forces of both groups were evaluated using a three-dimensional gait analysis system.Results After the intervention,the walking velocity,stride frequency and stride length had increased in the treatment group,while stride width had decreased.Significant improvement was observed in the treatment group in terms of the percentage of swing phase on the paretic side,the percentage of stance phase on the paretic side,the single support time ratio,the percentage of double support phase,the range of motion of the hip and knee joints,and the peak vertical and forward ground reaction force as a percentage of body weight.The improvements were significantly greater than those observed in the control group.Conclusions Compared with traditional walking training,robot-assisted gait training can be more effective in improving the walking ability of hemiplegic patients.
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Objective To explore the effect on walking ability of the orthotic insole produced by the International College of Biomechanics (ICB) when it is combined with an ankle foot orthosis (AFO).Methods A total of 40 stroke survivors with hemiplegia were randomly divided into an observation group and a control group,each of 20.In addition to conventional medical treatment and rehabilitation,the control group received AFOs and walking rehabilitation training.The observation group accepted walking training with an ICB orthotic insole combined with an AFO.The experiment lasted 4 weeks.Timed up and go test (TUGT) times,10 m maximum walking speed (10 m MWS) and Berg balance scale (BBS) ratings were recorded before and after the treatment.Results Before the treatment there was no significant difference between the group averages in terms of any of the measures.After the treatment,significant improvement was observed in all of the measurements,with the improvements in the observation group significantly better than those in the control group,on average.Conclusion An ICB orthotic insole combined with an AFO results in better improvements in the walking ability of hemiplegic subjects than an AFO alone.
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Objective To observe the effect of the 8-word bandage on the walking ability of stroke patients with knee hyperextension. Methods Fifty patients with stroke combined with knee hyperextension were randomly divided into the observation group and the control group with 25 cases in each group. The control group was treated with conventional methods, including Bobath technology, Brunnstrom therapy and motor relearning primarily rehabilitation training. In addition to the conventional methods, patients in the observation group used 8-word bandage to fix knee joint in walking training. Before and after 8 weeks of treatment, Holden walking function classification, 10-meter maximum walking speed and improved Barthel index were adopted to evaluate the walking ability, maximum walking speed and the life ability of the patients. Results There were no significant differences in the scores before treatment between the two groups. The Holden walking function classification, the 10-meter maximum walking speed and the Barthel index scores were significantly improved after 8-week treatment in both two groups (P<0.05), and patient conditions were more significantly improved in the observation group than those of the control group (P<0.05). Conclusion Using 8-word bandage to fix knee joint can significantly improve knee hyperextension in patients with stroke, so as to improve the walking ability and activities of daily living.
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Objective To explore the effect of sling exercise therapy (SET) for improving the balance and walking ability of patients with incomplete paraplegia.Methods The 37 patients were randomly divided into two groups:19 patients in the observation group and 18 cases in the control group.Both groups were given conventional rehabilitation training,including bridge training on the mat,kneeling position training,sit-stand training and orthosis walking training.The observation group was additionally provided with sling exercise therapy with multi-point,muhi axis sling suspension supine,prone with a neutral lumbar spine,supine with pelvic elevation and in a lateral position like an arch.Before the treatment and 6 weeks after the treatment,trunk control tests (TCTs) were administered.The Berg balance scale (BBS) and Holden's walking function classification were used to assess the subjects' balance and walking ability.Results There were no significant differences in the two groups' average TCT and BBS scores before the treatment.After 6 weeks of treatment the average scores of both groups had increased significantly,with a significantly bigger increase observed in the observation group.After the treatment,the average Holden classification of the observation group was significantly superior to that of the control group.Conclusion SET in addition to conventional rehabilitation training can significantly improve the balance and walking ability of patients with incomplete paraplegia.It is worthy of application in clinical practice.
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Objective To compare the walking abilities of an unilateral transfemoral amputee with four different prosthetic knee joints, to provide a reference for clinical prosthetic prescription. Methods An unilateral transfemoral amputee was asked to wear four kinds of pros-thetic knee joints, mechanical four-bar, pneumatic four-bar, hydraulic and intelligent prosthetic knee joints, and evaluated with Timed Up and Go Test, indoor 6-Minute Walk Test, Static Stand Balance Test and a 1000-meter Outdoor Walking Ability Test, wearing Intelligent De-vice for Energy Expenditure and Activity. Results The amputee consumed the least energy and walked the fastest with intelligent prosthetic knee joint. Conclusion There are some difference in walking ability with different prosthetic knee joints.
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Objective To compare the walking abilities of an unilateral transfemoral amputee with four different prosthetic knee joints, to provide a reference for clinical prosthetic prescription. Methods An unilateral transfemoral amputee was asked to wear four kinds of pros-thetic knee joints, mechanical four-bar, pneumatic four-bar, hydraulic and intelligent prosthetic knee joints, and evaluated with Timed Up and Go Test, indoor 6-Minute Walk Test, Static Stand Balance Test and a 1000-meter Outdoor Walking Ability Test, wearing Intelligent De-vice for Energy Expenditure and Activity. Results The amputee consumed the least energy and walked the fastest with intelligent prosthetic knee joint. Conclusion There are some difference in walking ability with different prosthetic knee joints.
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<p><b>Objectives:</b> This study was performed to elucidate the characteristics of amputees in our hospital. We also evaluated whether the causes and characteristics of the amputations influenced the patients’ prosthetic walking ability.</p><p><b>Materials and Methods:</b> We retrospectively examined 47 amputees in our hospital from December 1996 to April 2016 with respect to the causes and levels of amputation. Of 28 lower limb amputees from April 2008 to April 2016, 22 received prostheses and were divided into 2 groups according to the cause of the amputation, as follows: the internal cause group (e.g., vascular deficiency and infection) and the external cause group (e.g., trauma, burn injury, and crush syndrome). The characteristics and process of achieving prosthetic ambulation were compared between these groups.</p><p><b>Results:</b> Trauma was the most common cause of both upper (70.0%) and lower limb amputations (40.5%). Unilateral amputation was performed in 93.2% of patients (upper limb amputation, 100.0%; lower limb amputation, 91.9%). Patients were older in the internal than in the external cause group (<i>P</i> = 0.026). The serum albumin (<i>P</i> = 0.003) and total cholesterol concentrations (<i>P</i> = 0.046) on admission were significantly lower in the internal than in the external cause group. All patients in the internal cause group had comorbidities. The proportions of patients with diabetes mellitus (<i>P</i> = 0.011) and cerebrovascular disease (<i>P</i>=0.036) were significantly higher in the internal than in the external cause group. No significant difference in walking ability was found between the internal and external cause groups at the time of discharge.</p><p><b>Conclusion:</b> Most amputees in our hospital underwent unilateral lower limb amputation due to trauma. Although the patients with internal causes of amputation were older, more frequently had malnutrition, and had more comorbidities than those with external causes, they achieved prosthetic walking with statistically insignificant difference at the end of hospitalization, excluding six patients who had no prosthetic prescription.</p>
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PURPOSE: This investigation aimed to determine the effects of treadmill training (TT) and high frequency chest wall oscillation (HFCWO) on pulmonary function and walking ability in stroke patients as well as propose an exercise program to improve cardiovascular function. METHODS: Twenty hemiplegic stroke patients were randomized to either the control group (CG) (n=10) or the experimental group (EG), which received TT and HFCWO (n=10). Pulmonary function was quantitated using patient forced vital capacity (FVC) and forced expiratory volume at one second (FEV1) while walking speed was assessed by the 10m walking test (10MWT). Further, walking endurance was determined utilizing the 6-minute walk test (6MWT). Subjects of the EG performed the study protocol for 60 minutes, five times a week for six weeks; CG patients did not participate in regular exercise. To determine significance for the differences observed before and after exercise, within-group and between-group comparisons were conducted utilizing paired and independent t-tests, respectively, with the level of significance set at α=0.05. RESULTS: Within-groups, significant differences were observed in both FVC and FEV1 (p<0.01) following completion of the study protocol. Further, between-group comparisons demonstrated significant differences in both FVC (p<0.05) and FEV1 (p<0.01). Post-exercise, significant changes in the 10MWT and 6MWT score were observed between the EG and CG (p<0.01). Further, statistically significant differences were observed in 6MWT scores between-groups (p<0.05). CONCLUSION: The TT and HFCWO effectively improved pulmonary function and walking ability in subjects with stroke. The proposed program can be applied to stroke patients as a useful therapy.
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Humans , Chest Wall Oscillation , Forced Expiratory Volume , Stroke , Vital Capacity , WalkingABSTRACT
Objective To explore the effect of leg rehabilitation robot training on motor and activities of daily living in hemiplegic pa-tients after stroke. Methods From June, 2015 to July, 2016, 40 hemiplegic patients were randomly divided into control group (n=20) and ex-perimental group (n=20). Both groups received routine rehabilitation, and the experimental group received leg rehabilitation robot training in addition for six weeks. The Fugl-Meyer Assessment-Lower Limb (FMA-L), the Fugl-Meyer Assessment-Balance (FMA-B), Holden walk-ing function classification and modified Barthel Index (MBI) were used to access the motor function, balance function, walking ability and activities of daily living (ADL), respectively. Results After treatment, the scores of FMA-L, FMA-B, Holden walking function classification and MBI improved (χ2>8.980, t>3.902, P2.075, P<0.05). Conclusion Leg rehabilitation robot could facilitate to improve lower extremity motor function, balance function, walking ability and ADL in hemiplegic patients after stroke.