Effects of a 4-month judo program on gait performance in older adults.

BACKGROUND: Falls prevention is a critical goal of training program for older individuals. This study explored the effects of a judo program on gait performance in older adults. METHODS: Pre- and post-intervention (15 weeks, 1-hr session, twice a week) step length (cm), gait cycle time (s), speed (m·s-1) and cadence (step·min-1) mean values (AVG) and coefficients of variation (CV) were assessed in a judo (JG: N.=16 novice judoka; age=69.3±3.9 years) and a control (CG: N.=14 healthy older adults; age=70.1±4.5 years) group. Two 3 (motor complexity: flat, corridor, hurdling) ×2 (group: JG, CG) ×2 (time: pre, post) MANOVAs with repeated measures were applied to ascertain differences in gait parameters. RESULTS: A significant Time×Motor Complexity×Group interaction was found for AVG and CV. For AVG, JG showed improvements for flat and hurdling conditions in step length (flat: ∆=+2.6%, d=0.4; hurdling: ∆=+3.2%, d=0.4), gait cycle (flat: ∆=-4.3%, d=0.4; hurdling: ∆=-4.0%, d=0.5), speed (flat: ∆=+6.6%, d=0.7; hurdling: ∆=+6.7%, d=0.6) and cadence (flat: ∆=4.3%, d=0.4; hurdling: ∆=3.9%, d=0.5). For CV, JG improved step length for flat (∆=-20.9%, d=0.6) and hurdling (∆=-16.3%, d=0.8) conditions, whereas CG showed a deterioration in the step length for the corridor condition (∆=+22.3%, d=0.7). CONCLUSIONS: The findings demonstrated the effectiveness of an adapted judo program for improving gait performance in older individuals, suggesting a potential protective effect for fall risk.

Inertial measurement unit compared to an optical motion capturing system in post-stroke individuals with foot-drop syndrome.

BACKGROUND: Functional electrical stimulation (FES) can be used for compensation of foot-drop for post-stroke individuals by pre-programmed fixed stimulation; however, this stimulation seems no more effective than mechanical ankle foot orthoses. OBJECTIVE: We evaluated the metrological quality of inertial sensors for movement reconstruction as compared with the gold-standard motion capturing system, to couple FES with inertial sensors to improve dorsiflexion on the paretic side, by using an adaptive stimulation taking into account individuals' performance post-stroke. METHODS: Adults with ischemic or hemorrhagic stroke presenting foot-drop and able to walk 10m, were included from May 2016 to June 2017. Those with passive ankle dorsiflexion<0° with the knee stretched were excluded. Synchronous gait was analyzed with the VICON© system as the gold standard and inertial measurement units (IMUs) worn by participants. The main outcome was the dorsiflexion angle at the heel strike and mid-swing phase obtained from IMUs and the VICON system. Secondary outcomes were: stride length, walking speed, maximal ankle dorsiflexion velocity and fatigue detection. RESULTS: We included 26 participants [18 males; mean age 58 (range 45-84) years]. During heel strike, the dorsiflexion angle measurements demonstrated a root mean square error (RMSE) of 5.5°; a mean average error (MAE) of 3.9°; Bland-Altman bias of -0.1° with limits of agreement -10.9° to+10.7° and good intra-class correlation coefficient (ICC) at 0.87 between the 2 techniques. During the mid-swing phase, the RMSE was 5.6; MAE 3.7°; Bland-Altman bias -0.9° with limits of agreement -11.7° to+9.8° and ICC 0.88. Good agreement was demonstrated for secondary outcomes and fatigue detection. CONCLUSIONS: IMU-based reconstruction algorithms were effective in measuring ankle dorsiflexion with small biases and good ICCs in adults with ischemic or hemorrhagic stroke presenting foot-drop. The precision obtained is sufficient to observe the fatigue influence on the dorsiflexion and therefore to use IMUs to adapt FES.

Phase matters: A role for the subthalamic network during gait.

The role of the subthalamic nucleus in human locomotion is unclear although relevant, given the troublesome management of gait disturbances with subthalamic deep brain stimulation in patients with Parkinson's disease. We investigated the subthalamic activity and inter-hemispheric connectivity during walking in eight freely-moving subjects with Parkinson's disease and bilateral deep brain stimulation. In particular, we compared the subthalamic power spectral densities and coherence, amplitude cross-correlation and phase locking value between resting state, upright standing, and steady forward walking. We observed a phase locking value drop in the ß-frequency band (≈13-35Hz) during walking with respect to resting and standing. This modulation was not accompanied by specific changes in subthalamic power spectral densities, which was not related to gait phases or to striatal dopamine loss measured with [123I]N-ω-fluoropropyl-2ß-carbomethoxy-3ß-(4-iodophenyl)nortropane and single-photon computed tomography. We speculate that the subthalamic inter-hemispheric desynchronization in the ß-frequency band reflects the information processing of each body side separately, which may support linear walking. This study also suggests that in some cases (i.e. gait) the brain signal, which could allow feedback-controlled stimulation, might derive from network activity.

Avaliação da marcha em contexto clínico: uma revisão sistemática da literatura / Gait assessment in clinical context: a systematic literature review

Introdução: Em ambiente clínico é necessário recorrer a instrumentos de avaliação de rápida utilização e baixo custo, válidos, fiáveis e fáceis de interpretar. Nesta revisão, pretende-se identificar e caracterizar, do ponto de vista psicométrico e de interpretação clínica, instrumentos de avaliação da marcha utilizáveis na prática clínica. Métodos: A pesquisa foi realizada em cinco bases de dados utilizando combinações de várias palavras-chave. Elaborou-se uma lista dos instrumentos que cumpriam os critérios de inclusão, e fez-se nova pesquisa nas mesmas bases combinando o nome do instrumento com “validity”, “reliability”, “responsiveness” e “change score”. Resultados: Incluíram-se 15 instrumentos/ testes de avaliação. A maioria destes apresenta adequada a excelente confiabilidade e validade. A interpretação clínica dos dados recolhidos com os instrumentos analisados tem sido pouco estudada. Conclusão: São necessários mais estudos que avaliem os aspectos de interpretação clínica dos instrumentos/testes de avaliação da marcha e que validem estas ferramentas para a língua portuguesa.

Introduction: In clinical practice there is a need for instruments that are easy to use and affordable, but also, valid, reliable and from which clinical inferences are easy to make. This review aims to identify instruments for gait assessment that could easily be used in clinical practice and to characterize them in terms of psychometric properties and aspects of clinical interpretation. Methods : The search was conducted in five databases using combinations of different key words. A list of identified instruments that met the inclusion criteria was created and a second search conducted combining the name of the instrument with the words: “validity”, “reliability”, “responsiveness” and “change score”. Results: Fifteen instruments were included in this systematic review. Most of them showed adequate to excellent validity and reliability. Data regarding most aspects of clinical interpretation were missing. Conclusion: There is a need to study the identified instruments in terms of aspects of clinical interpretation and that validate them to Portuguese.