Implementation of a Mindful Walking Intervention in Breast Cancer Patients After Their Primary Oncologic Treatment: Results of a Qualitative Study Within a Randomized Controlled Trial.

BACKGROUND: Breast cancer survivors often suffer from diagnosis- and therapy-related long-term side effects, such as cancer related fatigue, restricted stress resilience and quality of life. Walking as a physical activity and mindfulness practice have been shown to be helpful in studies. The aim of this study was to compare the individual experiences and subjectively perceived effects of walking in combination with mindfulness practice with moderate walking alone in breast cancer patients. This paper focuses on the qualitative results of a mixed-methods pilot study. METHODS: Breast cancer patients who had finished their primary oncologic treatment at least 6 months ago were randomized to an 8-week group intervention program of either mindful walking or moderate walking. Within the qualitative study part, semi-structured focus group interviews (2 interviews per study arm) were conducted and analyzed using a qualitative content analysis approach. Audio recorded interviews were transcribed verbatim and pseudonymized. The subsequent data analysis was performed by using MAXQDA®. RESULTS: A total of 51 women (mean age 55.8 [SD 10.9] years) were included in the RCT, among these 20 (mean age 56.7 [SD 12.0] years) participated in the focus group interviews (n = 11 patients of the mindful walking group; n = 9 patients of the walking group). Breast cancer patients in both groups described different effects in the complex areas of self-efficacy, coping, body awareness and self-reflection. While mindful walking primarily promoted body awareness and inner strength by mindfulness in breast cancer patients, moderate walking promoted self-efficacy by a confidence of their body and an easily integrated and accepted way of physical activity. CONCLUSIONS: Study interventions and the study setting triggered processes and reflections on one's own health and situation. However, mindful walking and moderate walking seem to address different resources. This important knowledge may help oncologists and other therapists to assess what type of interventions can best meet the needs and requirements of individual patients. TRIAL REGISTRATION: DKRS00011521; prospectively registered 21.12.2016; https://drks.de/search/de/trial/DRKS00011521.

Towards efficient motor imagery interventions after lower-limb amputation.

BACKGROUND: The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations. OBJECTIVES: The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation. METHODS: Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks. RESULTS: While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group. CONCLUSION: Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

The effects of rhythmic auditory stimulation on functional ambulation after stroke: a systematic review.

BACKGROUND: Several studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet no systematic overview has yet been published. This study aims to synthesize the available evidence describing changes in stroke patients after RAS intervention for functional ambulation and the use of walking assistive devices, and to find out if the effect of RAS and music-based RAS differs depending on the lesioned area. METHODS: The PubMed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients, applying the PICOS criteria for the inclusion of studies. RESULTS: Twenty one articles were included (948 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may be as good as other complementary therapies (horse-riding and visual cueing). CONCLUSIONS: Despite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings. PROSPERO REGISTRATION: CRD42021277940.

Reduced center of mass acceleration during regular walking with electromyography biofeedback.

BACKGROUND: Regular walking in healthy adults is known to be kinematically stable, but it is unclear how to further kinematically stabilize regular walking. Electromyography biofeedback (EMG-BF) during walking improves walking ability in patients. However, the effect of EMG-BF on walking stability in healthy adults is unknown. Therefore, this study aimed to investigate whether EMG-BF enhances the stability of regular walking in healthy adults. RESEARCH QUESTION: Does the EMG-BF enhance the stability of regular walking in healthy adults? METHODS: Auditory biofeedback of single muscle activity was given to twelve participants during regular walking. The target muscles were the ankle plantar flexor, ankle dorsiflexor, and knee flexor. We compared the root mean square of the center of mass acceleration (RMS-CoMacc), which represents walking smoothness, between biofeedback conditions. RESULTS: We found that EMG-BF during regular walking partially reduced the RMS-CoMacc (p = 0.01). In particular, biofeedback of the ankle plantar flexor muscle reduced the RMS-CoMacc in both the anteroposterior and vertical directions. In the mediolateral RMS-CoMacc, no significant difference was found (p = 0.24). SIGNIFICANCE: Our study is novel because it is the first study to reveal the impact of EMG-BF on the stability of walking among healthy adults. It identifies the key muscles for EMG-BF, potentially leading to the development of a more effective EMG-BF system in the rehabilitation. Especially, biofeedback of the ankle plantar flexor muscle could improve walking stability in both the anteroposterior and vertical directions. The effect of EMG-BF for reducing the RMS-CoMacc during regular walking might depend on the target muscles of biofeedback.

Effects of ankle exoskeleton assistance and plantar pressure biofeedback on incline walking mechanics and muscle activity in cerebral palsy.

Ankle dysfunction affects more than 50 % of people with cerebral palsy, resulting in atypical gait patterns that impede lifelong mobility. Incline walking requires increased lower limb effort and is a promising intervention that targets lower-limb extensor muscles. A concern when prescribing incline walking to people with gait deficits is that this exercise may be too challenging or reinforce unfavorable gait patterns. This study aims to investigate how ankle exoskeleton assistance and plantar pressure biofeedback would affect gait mechanics and muscle activity during incline walking in CP. We recruited twelve children and young adults with CP. Participants walked with ankle assistance alone, biofeedback alone, and the combination while we assessed ankle, knee, and hip mechanics, and plantar flexor and knee extensor activity. Compared to incline walking without assistance or biofeedback, ankle assistance alone reduced the peak biological ankle moment by 12 % (p < 0.001) and peak soleus activity by 8 % (p = 0.013); biofeedback alone increased the biological ankle moment (4 %, p = 0.037) and power (19 %, p = 0.012), and plantar flexor activities by 9 - 27 % (p ≤ 0.026); assistance-plus-biofeedback increased biological ankle and knee power by 34 % and 17 %, respectively (p ≤ 0.05). The results indicate that both ankle exoskeleton assistance and plantar pressure biofeedback can effectively modify lower limb mechanics and muscular effort during incline walking in CP. These techniques may help in establishing personalized gait training interventions by providing the ability to adjust intensity and biomechanical focus over time.

Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review.

PURPOSE: To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. METHODS: Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. RESULTS: The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low-to-moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. CONCLUSION: FES has orthotic and therapeutic benefits. Certainty of evidence was low-to-moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.

Holographic Hintways: A systems feasibility and usability study of augmented reality cueing for gait adaptation.

BACKGROUND: Through providing on-demand visual and auditory cues while walking,augmented reality (AR) can theoretically cue spatiotemporal gait adaptations in, populations such as those with Parkinson's disease. However, given the novelty of the, technology, the type and extent of gait adaptations in response to such a cueing, system are unknown. Before such systems can be incorporated into rehabilitation, approaches, it is important to understand how people interact with the technology. RESEARCH QUESTIONS: What are the effects of visual and auditory cues delivered, through AR on spatiotemporal walking patterns and variability in a healthy, young, population? Is there a relationship between system usability and gait variability? , METHODS: Twenty healthy, young participants walked in four different cueing conditions using an AR headset: No Cues (NC) (i.e., natural gait), Auditory (A), Visual (V), and Auditory + Visual (AV). Inertial measurement units recorded spatiotemporal gait data at 200 Hz, a System Usability Survey was administered afterward, and linear regression models were developed to examine whether gait variability is predictive of system usability. RESULTS: All cueing conditions exhibited a significantly slower cadence compared to, NC trials. Cadence variability was significantly higher for A trials compared to V and, NC. V trials exhibited significantly decreased stride lengths compared to NC. Increased, reported system usability was significantly correlated with decreased stance phase, time variability across A trials. SIGNIFICANCE: Our findings support that holographic spatial-visual and auditory cues, are promising to evoke spatiotemporal gait adaptations. Results also support the, notion that the type of system and cue delivery design may impact gait outcomes.,Before an AR cueing system can be applied to a specific population in future, interventions, a more holistic approach towards finding the relationship between this, technology and its users is needed.

Effect of musical cues on gait in individuals with Parkinson disease with comorbid dementia.

BACKGROUND: Individuals with Parkinson disease and comorbid dementia (PDD) demonstrate gait impairments, but little is known about how these individuals respond to interventions for gait dysfunction. Rhythmic auditory stimulation (RAS), which utilizes music or other auditory cues to alter gait, has been shown to be effective for improving gait in individuals with PD without dementia, but has not been explored in individuals with PDD. RESEARCH QUESTION: Can individuals with PDD modulate their gait in response to music and mental singing cues? METHODS: This single center, cross-sectional, interventional study included 17 individuals with PDD. Participants received Music and Mental singing cues at tempos of 90 %, 100 %, 110 %, and 120 % of their uncued walking cadence. Participants were instructed to walk to the beat of the song. Gait variables were collected using APDM Opal sensors. Data were analyzed using mixed effect models to explore the impact of tempo and cue type (Music vs Mental) on selected gait parameters of velocity, cadence, and stride length. RESULTS: Mixed effects models showed a significant effect of tempo but not for cue type for velocity (F=11.51, p < .001), cadence (F=11.13, p < .001), and stride length (F=5.68, p = .002). When looking at the marginal means, velocity at a cue rate of 90 % was significantly different from 100 %, indicating participants walked slower with a cue rate of 90 %. Participants did not significantly increase their velocity, cadence, or stride length with faster cue rates of 110 % and 120 % SIGNIFICANCE: Individuals with PDD appear to be able to slow their velocity in response to slower cues, but do not appear to be able to increase their velocity, cadence, or stride length in response to faster cue tempos. This is different from what has been reported in individuals with PD without dementia. Further research is necessary to understand the underlying mechanism for these differences.

Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial-A Preliminary Study.

Spinal cord injury (SCI) is damage to any part of the spinal cord resulting in paralysis, bowel and/or bladder incontinence, and loss of sensation and other bodily functions. Current treatments for chronic SCI are focused on managing symptoms and preventing further damage to the spinal cord with limited neuro-restorative interventions. Recent research and independent clinical trials of spinal cord stimulation (SCS) or intensive neuro-rehabilitation including neuro-robotics in participants with SCI have suggested potential malleability of the neuronal networks for neurological recovery. We hypothesize that epidural electrical stimulation (EES) delivered via SCS in conjunction with mental imagery practice and robotic neuro-rehabilitation can synergistically improve volitional motor function below the level of injury in participants with chronic clinically motor-complete SCI. In our pilot clinical RESTORES trial (RESToration Of Rehabilitative function with Epidural spinal Stimulation), we investigate the feasibility of this combined multi-modal approach in restoring volitional motor control and achieving independent overground locomotion in participants with chronic motor complete thoracic SCI. Secondary aims are to assess the safety of this combination therapy including the off-label SCS usage as well as improving functional outcome measures. To our knowledge, this is the first clinical trial that investigates the combined impact of this multi-modal EES and rehabilitation strategy in participants with chronic motor complete SCI. Two participants with chronic motor-complete thoracic SCI were recruited for this pilot trial. Both participants have successfully regained volitional motor control below their level of SCI injury and achieved independent overground walking within a month of post-operative stimulation and rehabilitation. There were no adverse events noted in our trial and there was an improvement in post-operative truncal stability score. Results from this pilot study demonstrates the feasibility of combining EES, mental imagery practice and robotic rehabilitation in improving volitional motor control below level of SCI injury and restoring independent overground walking for participants with chronic motor-complete SCI. Our team believes that this provides very exciting promise in a field currently devoid of disease-modifying therapies.

Sweet-type star fruit supplementation controls oxidative stress status and enhances the community walking capacity among elderly Thai.

BACKGROUND: Sweet-type Star fruit (SF) (Averrhoa carambola L.) is seasonal and more available for purchase in many markets in Thailand, when compared to the sour-type. But, its antioxidant activity results and potentially more modified supplement for elderly health during regular exercise in the community are unclear. OBJECTIVE: This study aimed to evaluate the antioxidant activity and physical capacity from supplementation of sweet-type SF among elderly people performing home walking exercise. METHODS: Mixing SF juice with honey industrially prepared the SF product. Its effects on oxidative stress status and physical capacity were studied in four groups; a supplement with walking exercise (n = 11, 67.00 ± 4.17 years), control (n = 12, aged 67.50 ± 5.58 years), supplementation (n = 11, aged 69.63 ± 7.14 years), and walking exercise (n = 12, aged 67.91 ± 4.33 years). Twenty grams or two teaspoons of supplement in warm water (150 mL) was the guideline for consumption twice daily for 4 weeks. In contrast, the walking exercise was prescribed with moderate intensity for 30 min, 3 days per week. Before and after the 4-week period, the oxidative stress status; glutathione (GSH), ascorbic acid (Vit C), total antioxidant capacity (TAC), and malondialdehyde (MDA), and 6-minute walking distance (6MWD) were evaluated. RESULTS: Results after the 4-week period, showed that Vit C and TAC increased and the MDA decreased significantly in the supplementation group, except the GSH and 6MWD results. The GSH and Vit C slightly decreased in the walking exercise group, whereas, its TAC, MDA and 6MWD increased significantly. Finally, The GSH and Vit C did not decrease and MDA slightly decreased in the combined group, but, their TAC and 6MWD increased significantly. CONCLUSION: Supplementation of the SF product during walking exercise possibly controls oxidative stress status and may enhance walking capacity.

Audiovisual biofeedback amplifies plantarflexor adaptation during walking among children with cerebral palsy.

BACKGROUND: Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP. However, it is currently unclear how the modality of biofeedback may influence user response which has significant implications if systems are to be consistently adopted into clinical care. METHODS: In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 [12.5,15.5] years) adapted their gait patterns during treadmill walking (6 min/modality) with audiovisual (AV), sensorimotor (SM), and combined AV + SM biofeedback before and after four acclimation sessions (20 min/session) and at a two-week follow-up. Both biofeedback systems were designed to target plantarflexor activity on the more-affected limb, as these muscles are commonly impaired in CP and impact walking function. SM biofeedback was administered using a resistive ankle exoskeleton and AV biofeedback displayed soleus activity from electromyography recordings during gait. At every visit, we measured the time-course response to each biofeedback modality to understand how the rate and magnitude of gait adaptation differed between modalities and following acclimation. RESULTS: Participants significantly increased soleus activity from baseline using AV + SM (42.8% [15.1, 59.6]), AV (28.5% [19.2, 58.5]), and SM (10.3% [3.2, 15.2]) biofeedback, but the rate of soleus adaptation was faster using AV + SM biofeedback than either modality alone. Further, SM-only biofeedback produced small initial increases in plantarflexor activity, but these responses were transient within and across sessions (p > 0.11). Following multi-session acclimation and at the two-week follow-up, responses to AV and AV + SM biofeedback were maintained. CONCLUSIONS: This study demonstrated that AV biofeedback was critical to increase plantarflexor engagement during walking, but that combining AV and SM modalities further amplified the rate of gait adaptation. Beyond improving our understanding of how individuals may differentially prioritize distinct forms of afferent information, outcomes from this study may inform the design and selection of biofeedback systems for use in clinical care.

Biomechanical comparison of human trunk and thigh muscle activity during walking and horseback riding activity.

INTRODUCTION: Hippotherapy is a physical therapy tool that utilizes horseback riding to improve strength, coordination, gait, and balance. These benefits may be linked to similarities in kinematics and muscle activation between horseback riding and normal human gait, but this is not well represented in the literature, especially for muscle activation. The purpose of this study was to investigate the relationships between muscle activation of horseback riding and healthy human gait. METHODS: The muscle activation of nine healthy female participants (age 18-22) were recorded during walking and horseback riding trials using surface electromyography (EMG). Muscles analyzed include rectus abdominis, lumbar erector spinae, rectus femoris and biceps femoris. Activation waveforms during walking and riding were generated, and from this average and maximum contraction magnitudes were recorded. RESULTS: Average muscle activation was significantly greater in riding for the left (p = 0.008) and right (p = 0.04) biceps femoris. Additionally, average and maximal activation of the left erector spinae were significantly greater in riding (W = 4; critical value for W at n = 9 is 5). Remaining differences in muscle activation between walking and riding were non-significant. DISCUSSION: Peak and average muscle activation magnitude across the gait cycle were similar for most muscle groups. When present, differences were greater in riding. Despite these similarities, EMG waveforms displayed more predictable temporal patterns in walking. CONCLUSION: These findings suggest that hippotherapy could be used to elicit muscle excitation similar to that of normal gait, which may have promising implications for rehabilitation targeting gait correction.

Comparing the effects of 30 minutes exergaming versus brisk walking on physiological and psychological measurements of older adults.

BACKGROUND: Active video games can make physical activity more appealing and enjoyable for older people. This study compared the effects of 30 min of Exergaming versus walking on the physiological and psychological measures of asymptomatic older adults. METHODS: Forty eligible participants (mean age = 69.60 ± 4.16 y/o) were randomly divided into two groups of 20 in a crossover design, who either performed Brisk Walking or Exergaming, one week apart. Before each session, each participant's blood pressure was measured, and the subjects were encouraged to play/walk continuously for 30 min using a self-selected intensity. During both sessions, average and peak heart rate, time spent in each of the heart rate zones, blood pressure, and double product were assessed through a Polar H10 heart rate monitor. Participants also filled out the modified Physical Activity Enjoyment Scale (PACES) questionnaire and Rate of Perceived Exertion (RPE) scale. RESULTS: Findings indicated a significantly higher average (P = 0.003) and peak heart rate (P < 0.001) and double product (P = 0.002) during Exergaming compared to Brisk Walking. Also, the RPE score was significantly lower and PACES score was significantly higher (P < 0.001) during the Exergaming session. The analyses of blood pressure showed significant changes in systolic and diastolic blood pressures following each session, while no statistically significant difference was reported between the two exercise modalities (P = 0.012 and P < 0.001, respectively). CONCLUSION: This study showed that Exergaming can be a good alternative to traditional exercises like walking for older adults, providing physiological benefits while being less exhausting and more enjoyable.

Biomechanical Gait Effects of a Single Intervention with Wearable Closed Loop Control FES System in Chronic Stroke Patients. A Proof-of-Concept Pilot Study.

Foot drop is a gait disturbance characterized by difficulty in performing ankle dorsiflexion during the swing phase of the gait cycle. Current available evidence shows that functional electrical stimulation (FES) on the musculature responsible for dorsal ankle flexion during gait can have positive effects on walking ability. This study aims to present a proof of concept for a novel easy-to-use FES system and evaluates the biomechanical effects during gait in stroke patients, compared to unassisted walking. Gait was quantitatively evaluated in a movement analysis laboratory for five subjects with chronic stroke, in basal condition without assistance and in gait assisted with FES. Improvements were found in all temporospatial parameters during FES-assisted gait, evidenced by statistically significant differences only in gait speed (p=0.02). Joint kinematics showed positive changes in hip abduction and ankle dorsiflexion variables during the swing phase of the gait cycle. No significant differences were found in the Gait Deviation Index. In conclusion, the present pilot study demonstrates that the use of this FES system in the tibialis anterior muscle can cause gait functional improvements in subjects with foot drop due to chronic stroke.

12-week concurrent brisk walking and Taijiquan (Tai Chi) improve balance, flexibility, and muscular strength of Chinese older women.

Healthy aging is a global goal to enhance the quality of life for older persons. This study evaluated the benefits of 12-week concurrent brisk walking and Taijiquan. Healthy Chinese women aged 60 years and above were enrolled to the control (n = 26) and intervention (n = 25) groups. Participants in the intervention group engaged in three exercise sessions per week for 12 weeks, whereas control group engaged in free-living activities. Each exercise session consisted of 20-45 minutes of walking and 20-45 minutes of Yang style 24-form Taijiquan. 12-week exercise improved (p < 0.05) the sit and reach test (within-group mean difference: +5.6 cm; Hedges' g = 0.77), handgrip strength (mean difference: +3.1 kg; g = 0.89), arm curl (mean difference: +2.1 repetitions; g = 0.69), chair stand (mean difference: +2.6 repetitions; g = 0.63), and one-legged standing (mean difference: +2.2 seconds; g = 1.07). There was no improvement in the circulatory health, body composition, or life satisfaction. Therefore, this concurrent brisk walking and Taijiquan training, which targets major whole-body muscle groups, could improve aging-critical flexibility, muscular fitness, and balance in older women. The exercise meets the current WHO guideline, is safe to perform, and could be campaigned as a health promotion for older persons.

Effect of the haptic anchors during balancing and walking tasks in older adults: A systematic review.

BACKGROUND: Older adults are benefited from the continuous tactile information to enhance postural control. Therefore, the aim was to evaluate the effect of the haptic anchors during balancing and walking tasks in older adults. METHODS: The search strategy (up to January 2023) was based on the PICOT (older adults; anchor system during balance and walking tasks; any control group; postural control measurements; short and/or long-term effect). Two pairs of reviewers independently examined all titles and abstracts for eligibility. The reviewers independently extracted data from the included studies, assessed the risk of bias, and certainty of the evidence. RESULTS: Six studies were included in the qualitative synthesis. All studies used a 125-g haptic anchor system. Four studies used anchors when standing in a semi-tandem position, two in tandem walking on different surfaces, and one in an upright position after plantar flexor muscle fatigue. Two studies showed that the anchor system reduced body sway. One study showed that the ellipse area was significantly lower for the 50% group (reduced frequency) in the post-practice phase. One study showed that the reduction in the ellipse area was independent of the fatigue condition. Two studies observed reduced trunk acceleration in the frontal plane during tandem waking tasks. The studies had low to moderate certainty of evidence. CONCLUSION: Haptic anchors can reduce postural sway during balance and walking tasks in older adults. Also, positive effects were seen during the delayed post-practice phase after the removal of anchors only in individuals who used a reduced anchor frequency.

Walking naturally after spinal cord injury using a brain-spine interface.

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis1,2. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking4-6. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.

Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic cerebral palsy.

BACKGROUND: Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. RESEARCH QUESTION: Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming? METHODS: Eighteen children (6-17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire. RESULTS: Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10). SIGNIFICANCE: This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.

Variable Cadence Gait Training Outcomes Using Rhythmic Auditory Stimulation Embedded in Older Adults' Preferred Music.

Older adults must have the ability to walk at variable speeds/distances to meet community demands. This single group pre-post test study's purposes were to examine if actual cadences after 7 weeks of rhythmic auditory stimulation gait training matched target cadences, improved walking distance, duration, velocity, maximum cadence, balance, enjoyment, and/or changed spatial/temporal gait parameters. Fourteen female adults (72.6 ± 4.4 years) participated in 14 sessions, while variable cadences were progressively introduced. Eleven older adult responders walked faster (3.8 steps/min) than one target cadence (-10% pace) while matching the target cadences for the other paces when walking with rhythmic auditory stimulation. Two nonresponders walked near their baseline cadence with little variability while one walked at faster cadences; all three did not appear to adjust to the beat of the music. After training, participants increased their walking distance, 90.8 ± 46.5 m; t(1, 13) = -7.3; p ≤ .005, velocity, 0.36 ± 0.15 m/s; t(1, 40) = -15.4; p < .001, and maximum cadence, 20.6 ± 9.1 steps/min; t(1, 40) = -14.6; p < .001; changes exceeded minimal clinically important differences. Twelve of 14 expressed enjoyment. Walk with rhythmic auditory stimulation training is a promising activity for older adults, which may translate to an individual's ability to adapt walking speeds to various community demands.

Study on Two Typical Progressive Motions in Tai Chi (Bafa Wubu) Promoting Lower Extremity Exercise.

BACKGROUND: By comparatively investigating the joints, muscles and bones of the lower extremity during two progressive motions in Bafa Wubu and normal walking, this paper aims to enrich the diversity of walking exercise and scientifically provide theoretical guidance for primary practitioners. The scientific training methods and technical characteristics of Bafa Wubu, as well as its contribution to comprehensive exercise of the lower extremities, are further explored. METHODS: A total of eight professional athletes of Tai Chi at the national level were recruited. The kinetic parameters of the lower extremity were calculated using AnyBody 7.2 musculoskeletal modeling. Stress analysis of the iliac bone was performed using an ANSYS 19.2 workbench. RESULTS: In Bafa Wubu, the ground reaction force during two progressive motions was significantly smaller than that noted during normal walking. During warding off with steps forward and laying with steps forward, the load at the three joints of the lower extremity was significantly smaller than that during normal walking in the frontal plane, but significantly greater than that noted during normal walking in the vertical axis. In addition, the lower limb joint torque was higher than that of normal walking in both progressive movements, and lower limb muscle activation was higher. The iliac bone loads during the two progressive motions were larger than those during normal walking, and the maximum loading point differed. CONCLUSIONS: This is the first study to demonstrate the biomechanical performance of Bafa Wubu in professional athletes of Tai Chi. Two progressive motions of Bafa Wubu require the lower extremity to be slowly controlled, thereby resulting in a smaller ground reaction force. In addition, the loads of the three joints at the lower extremity all increase in the vertical direction and decrease in the lateral direction, reducing the possibility of lateral injury to the joints. In addition, the two progressive motions significantly enhance the muscle strength of the plantar flexion muscles, dorsiflexor, and muscles around the thigh, and effectively stimulate the bones of the lower extremity. Therefore, progressive motion training contributes to improving the controlling and supporting capabilities of the lower extremities during normal walking.