RESUMEN
This cross-sectional study was conducted among a rural elderly population of 725 individuals aged over 60 years from Eastern India to assess the association of multiple chronic diseases with frailty and dependence. Multimorbidity, frailty, and dependence were assessed using prevalidated tools. Regression models were used to assess the association between variables and adjust for confounders. The overall prevalence of multimorbidity was 48.8 % and that of frailty and dependence for activities of daily living was 58.6 % and 5.4 %, respectively. There was no statistically significant difference (pâ¯=â¯0.53) between the mean age of persons with and without multimorbidity. Frailty and dependency, however, showed a significant increasing trend with the mean age. Unadjusted bivariate analyses showed a significantly larger proportion of persons who were frail or at risk of frailty having multimorbidity as compared to those who were robust. Logistic regression models showed a significant association between risk of frailty and multimorbidity but failed to demonstrate a significant relationship between dependency and number of chronic diseases when adjusted for the interaction between frailty and chronic diseases. There was a significant association between dependence, frailty, and multimorbidity. Further research to determine the extent, direction, and nature of this complex relationship needs to be explored.
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Actividades Cotidianas , Deambulación Dependiente , Fragilidad , Afecciones Crónicas Múltiples , Medición de Riesgo/métodos , Anciano , Estudios Transversales , Dependencia Psicológica , Deambulación Dependiente/fisiología , Deambulación Dependiente/psicología , Evaluación de la Discapacidad , Femenino , Fragilidad/diagnóstico , Fragilidad/epidemiología , Fragilidad/fisiopatología , Evaluación Geriátrica/métodos , Humanos , India/epidemiología , Masculino , Afecciones Crónicas Múltiples/epidemiología , Afecciones Crónicas Múltiples/terapia , Prevalencia , Factores de Riesgo , Población Rural/estadística & datos numéricosRESUMEN
Purpose: This Australian study piloted a new measure of Orientation and Mobility to better understand the functional mobility of guide dog handlers with low vision or blindness. It is expected that this measure can be used to better match guide dogs to their handlers.Materials and methods: The new Orientation and Mobility Outcomes tool scores a client in Stable/Familiar and Dynamic/Unfamiliar conditions, also considering Travel-Related Wellbeing. Semi-structured interviews were conducted with 51 guide dog handlers, during which travel skills were co-rated with an interviewer.Results: A cluster analysis of the Orientation and Mobility Outcomes data identified four mobility styles: intrepid explorers, social navigators, independent roamers and homebodies. The differences between these clusters had more to do with mental mapping skills than level of vision, and different guide dog characteristics were needed to support the travel styles identified for each cluster.Conclusions: The results confirm the importance of the Orientation and Mobility Outcomes tool as a sensitive, person-centred measure of the impact of Orientation and Mobility and guide dog training. In particular, the four mobility clusters provide a new perspective on matching guide dogs with clients, also suggesting the need for a more personalised look at the guide dog training process.Implications for RehabilitationOrientation and Mobility Outcomes data seem precise enough to support and inform the process of matching guide dogs to handlers.Uniform results cannot be expected from guide dog mobility in handlers - age, stage of life, health and spatial cognition impact the competence and travel style of guide dog handlers, whereas vision is less important.Sharing the work of visual interpretation and decision making with a guide dog makes independent travel more possible.Valuable dog characteristics that are specific to handler requirements might be bred or trained from puppy raising onwards, creating a more diverse pool of dogs to draw upon.
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Ceguera/rehabilitación , Deambulación Dependiente , Orientación Espacial , Rehabilitación , Animales de Servicio/psicología , Animales , Australia , Ceguera/fisiopatología , Ceguera/psicología , Deambulación Dependiente/fisiología , Deambulación Dependiente/psicología , Perros , Humanos , Rehabilitación/métodos , Rehabilitación/organización & administración , Rehabilitación/normasRESUMEN
PURPOSE: The present small semi-controlled feasibility study investigated a possible efficacy of a combined upper limb and breathing exercise programme in managing pain in ambulatory and non-ambulatory patients with EDSS from 0.0-8.0. METHOD: People with MS (N = 19) were enrolled in this single-blind randomized controlled study and divided into 2 groups: exercise group (5 ambulatory, 5 non-ambulatory; Expanded Disability Status Scale (EDSS), 1.0-8.0) and related control group that performed no exercise (4 ambulatory, 5 non-ambulatory; EDSS, 1.0-7.5). The exercise group performed combined upper limb and breathing exercises in a group led by a physiotherapist (2 days/week, 60 min/session) accompanied by independent home exercises (3 days/week, ≥ 20 min/session). Participants underwent measures of pain level (visual analogue scale) for physical pain, functional independence of daily activities (Barthel index) and handgrip strength (HGS) for dominant (D) and non-dominant (ND) hand evaluated by a dynamometer before and after the 4-week period by the blinded assessor. RESULTS: The VAS for pain showed statistically significant group-by-time interaction only in non-ambulatory (p = .049) individuals, but with large intervention effects on both subgroups (ambulatory, p = .159; non-ambulatory, d = 0.97). Functional independence in daily activities (Barthel index) showed statistically non-significant group-by-time interaction in ambulatory (p = .195, d = 0.89) and non-ambulatory (p = .102, d = 1.64) individuals, but despite the absence of statistical significance, there were large intervention effects. Handgrip strength was significantly improved for both hands in ambulatory (D, p = .012; d = 2.07; ND, p = .025, d = 1.77) and only non-dominant hand in non-ambulatory individuals (D, p = .288, d = 0.83; ND, p = .012, d = 2.21). CONCLUSION: This small pilot study provides preliminary proof-of-concept data supporting low-intensity upper limb and breathing exercise programme for potential reduction of pain and improvement of functional independence in both ambulatory and non-ambulatory individuals with MS in a larger sample and that strengthening the upper limbs might be an additional pain relief mechanism. TRIAL REGISTRATION: NTC03222596.
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Ejercicios Respiratorios/métodos , Deambulación Dependiente/fisiología , Terapia por Ejercicio/métodos , Esclerosis Múltiple/terapia , Manejo del Dolor/métodos , Extremidad Superior/fisiología , Adulto , Anciano , Terapia Combinada/métodos , Estudios de Factibilidad , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/fisiopatología , Proyectos Piloto , Método Simple CiegoRESUMEN
BACKGROUND: Locomotor training has been used to improve walking function in people with incomplete spinal cord injury (iSCI), but functional gains are relatively small for some patients, which may be due to the lack of weight shifting training. OBJECTIVE: To determine whether applying a pelvis assistance force in the coronal plane during walking would improve weight shifting and stepping in people with iSCI. DESIGN: Repeated measures study. SETTING: Rehabilitation hospital. PARTICIPANTS: Seventeen people with iSCI. INTERVENTIONS: A controlled assistance force was bilaterally applied to the pelvis in the medial-lateral direction to facilitate weight shifting, which gradually increased during the course of treadmill walking. MAIN OUTCOME MEASURES: Weight shifting, step length, margin of stability, and muscle activities of the weaker leg were used to quantify gait performance. The spatial-temporal gait parameters during overground walking were collected pre, post, and 10 minutes after treadmill training. RESULTS: During treadmill walking, participants significantly improved weight shifting (ie, center of mass [CoM] lateral distance reduced from 0.16 ± 0.06 m to 0.12 ± 0.07 m, P = .012), and increased step length (from 0.35 ± 0.08 m to 0.37 ± 0.09 m, P = .037) on the stronger side when the force was applied, which were partially retained (ie, CoM distance was 0.14 ± 0.06, P = .019, and step length was 0.37 ± 0.09 m, P = .005) during the late postadaptation period when the force was removed. In addition, weight shifting and step length on the weaker side during overground walking also improved (support base reduced from 0.13 ± 0.06 m to 0.12 ± 0.06 m, P = .042, and step length increased from 0.48 ± 0.12 m to 0.51 ± 0.09 m, P = .045) after treadmill training. CONCLUSIONS: Applying pelvis assistance during treadmill walking may facilitate weight shifting and improve step length in people with SCI, which may partially transfer to overground walking. LEVEL OF EVIDENCE: III.
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Adaptación Fisiológica , Prueba de Esfuerzo/métodos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Adulto , Peso Corporal , Deambulación Dependiente/fisiología , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Equilibrio Postural/fisiología , Muestreo , Factores de TiempoRESUMEN
PURPOSE: To investigate the effects of high-intensity interval training (HIT) on physical fitness and cardiometabolic health in youth with physical disabilities. METHODS: For this quasi-experimental study 70 participants were recruited from schools for special education and divided into runners and users of wheelchairs. HIT was performed for 8 weeks, twice a week, containing 30 seconds all-out exercises. RESULTS: Exercise adherence was 84.5%. Following HIT, there were improvements in anaerobic performance, agility, aerobic performance, and systolic and diastolic blood pressure. There were no changes in peak oxygen uptake ((Equation is included in full-text article.)O2peak), arterial stiffness, body composition, lipid profile, and fasting glucose. CONCLUSIONS: Both anaerobic and aerobic performance improved after HIT, with no changes in (Equation is included in full-text article.)O2peak. There were no effects on cardiometabolic health, except for a decrease in blood pressure.
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Niños con Discapacidad/rehabilitación , Entrenamiento de Intervalos de Alta Intensidad , Aptitud Física/fisiología , Adolescente , Presión Sanguínea , Composición Corporal , Niño , Deambulación Dependiente/fisiología , Prueba de Esfuerzo , Terapia por Ejercicio , Femenino , Humanos , Masculino , Limitación de la Movilidad , Consumo de Oxígeno , Carrera/fisiología , Adulto JovenRESUMEN
BACKGROUND: Fall risk in elderly has been related with physical decline, low quality of life and reduced survival. AIM: To evaluate the impact of exoskeleton human body posturizer (HBP) on the fall risk in the elderly. METHODS: 150 subjects (mean age 64.85; 79 M/71 F) with mild fall risk were randomized into two groups: 75 for group treated with human body posturizer (HBP group) and 75 for physical training without HBP group (exercise group). The effects of interventions were assessed by differences in tests related to balance and falls. Medically eligible patients were screened with Tinetti balance and Gait evaluation scale, short physical performance battery and numeric pain rating scale to determine fall risk in elderly people. RESULTS: In the HBP group there was a significant improvement in short physical performance battery, Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk (p < 0.05). In the exercise group we observed only minimal variations in the test scores. DISCUSSION: The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain. CONCLUSION: The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients. Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly.
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Accidentes por Caídas/prevención & control , Envejecimiento , Marcha/fisiología , Equilibrio Postural/fisiología , Calidad de Vida , Dispositivos de Autoayuda , Anciano , Envejecimiento/fisiología , Envejecimiento/psicología , Deambulación Dependiente/fisiología , Terapia por Ejercicio/métodos , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Examen Neurológico/métodos , Resultado del TratamientoRESUMEN
Introducción. El síndrome de Down (SD) es un trastorno cromosómico de expresión fenotípica variable, aunque con rasgos comunes en los distintos pacientes. Entre ellos, destaca la hipotonía, hiperlaxitud ligamentosa y el retraso en el desarrollo psicomotor. Estos rasgos mejoran con la terapia temprana, pero persisten en forma de inestabilidad de la marcha y compensaciones patológicas en el adulto. La marcha patológica en estos pacientes ha sido objeto de estudios previos, pero el tratamiento de los problemas motores no ha sido abordado desde un enfoque neurorrehabilitador, dirigido a la calidad del funcionamiento. Objetivos. El propósito del presente estudio es describir las alteraciones de la marcha en una muestra de pacientes con SD y evaluar los cambios después del tratamiento con fisioterapia Bobath. Material y métodos. Estudio prospectivo experimental de tipo ensayo no controlado. Diez personas adultas con SD (edad media: 28 años) fueron evaluadas en situación basal y después de 10 sesiones de fisioterapia Bobath. Se recogieron variables cuantitativas (como longitud del paso, velocidad de la marcha) y variables cualitativas (como calidad del braceo o inestabilidad) a través de un evaluador ciego al tratamiento fisioterápico. Resultados. Se encontraron claras desviaciones respecto a la marcha adulta normal y una tendencia a la mejoría después del tratamiento fisioterápico. Esta mejoría fue significativa en la corrección del ángulo y en la simetría del paso. Se pone de manifiesto el potencial beneficio de la fisioterapia en adultos con SD y alteraciones de la marcha, así como la necesidad de realizar más estudios en este sentido (AU)
Introduction. Down syndrome (DS) is a chromosomal disorder with variable phenotypic expression, although different patients share some common features. Among them, hypotonia, ligament laxity and delayed psychomotor development stand out. These traits can improve with early therapy, but remain as gait instability and pathologic compensatory strategies in adult patients. Pathological gait in DS patients has been studied previously, but the treatment of motor problems has not been approached from a neurological rehabilitation viewpoint, focused on quality of function. Objectives. The aim of this study was to describe the gait alterations in a sample of patients with DS and to assess changes after Bobath physiotherapy. Material and methods. An experimental prospective uncontrolled study was performed. Ten adults with DS (mean age: 28 years) were assessed at baseline and after 10 sessions of Bobath physiotherapy treatment. Quantitative data (such as step length or walking speed) and qualitative data (such as characteristics of arm movements and instability) were recorded by an evaluator blinded to the treatment received. Results. Clear deviations with respect to normal adult gait were found, and a trend towards improvement after physiotherapy treatment. The results were significant in the correction of pitch angle and its symmetry. The study has revealed the potential benefits of physiotherapy in adults with DS and the need to complete more studies in this sense (AU)
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Humanos , Masculino , Femenino , Adulto , Marcha/fisiología , Ataxia de la Marcha/epidemiología , Ataxia de la Marcha/terapia , Desempeño Psicomotor/fisiología , Modalidades de Fisioterapia/organización & administración , Modalidades de Fisioterapia/normas , Modalidades de Fisioterapia , Deambulación Dependiente/fisiología , Estudios Prospectivos , Caminata/fisiología , Limitación de la Movilidad , 28599RESUMEN
BACKGROUND: Care-needing older adults and disabled individuals often require handrails for assistance of movements, such as sit-to-stand movements. Handrails must be set at the appropriate position; however, the effects of handrail height on joint movement and center-of-gravity movements during sit-to-stand movement remain unclear. In the present study, we sought to clarify the effects of handrail height on joint movement, center-of-gravity, and floor reaction force during sit-to-stand movement. METHODS: Subjects included 16 healthy young adults and 25 older adults who require long-term care. Kinetic and kinematic measurements during sit-to-stand movement of young adults were conducted using a 3-D motion analyzer and a force plate. Trunk forward tilt angle during sit-to-stand movement of older adults was measured using a still image from a video recording. RESULTS: Using low handrails, sit-to-stand movement resulted in an increased hip flexion angle, ankle dorsiflexion angle, and trunk forward tilt angle and a greater forward center-of-gravity shift than when not using handrails in young adults during seat-off. In contrast, using high handrails resulted in a smaller hip flexion angle and trunk forward tilt angle in young adults. The backward force on the floor was decreased in the low handrail condition, and was increased in the high handrail condition rather than that of sit-to-stand movement without handrails in young adults. The effect of handrail height on trunk forward tilt angle was the same in both healthy young adults and care-needing older adults during seat-off. CONCLUSION: Because handrail height affects joint movement and shift in the center-of-gravity during sit-to-stand movement, handrail position should be selected to match the status of older adults with functional impairment.
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Movimiento/fisiología , Postura/fisiología , Dispositivos de Autoayuda , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Pesos y Medidas Corporales , Deambulación Dependiente/fisiología , Femenino , Humanos , Masculino , Rango del Movimiento Articular , Adulto JovenRESUMEN
OBJECTIVE: To develop a video-based system, mounted on a rollator to quantify the step width values of rollator users in the community. SUBJECTS: A total of 5 able-bodied young adults, age range 24-28 years. METHODS: A digital video camera system was mounted on the rollator frame to capture the position of the participant's feet during overground walking. A method of estimating step width from the video data was developed and evaluated against the output from a concurrently recording Vicon MX motion capture system. RESULTS: Mean step widths of the rollator and motion capture systems were 14.40 cm (standard deviation (SD) 4.64) and 14.37 cm (SD 4.34), respectively, revealing a strong level of agreement; intra-class correlation coefficient 0.999 (95% confidence interval (95% CI) 0.987-1.000; and root-mean-square difference 0.70 cm. CONCLUSION: The video-based system mounted on a rollator to collect foot placement data enabled accurate measurement of step width during rollator use. The ability to record foot placement measurements outside the laboratory setting, characterizing foot placement patterns occurring in the community, will enable research into how these assistive devices influence mobility during everyday use.
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Deambulación Dependiente/fisiología , Pie/fisiología , Marcha , Monitoreo Ambulatorio/métodos , Grabación en Video/métodos , Adulto , Femenino , Humanos , Masculino , Monitoreo Ambulatorio/instrumentación , Dispositivos de Autoayuda , Grabación en Video/instrumentación , Adulto JovenRESUMEN
Gait function is one of the most important components of functional outcome evaluation in patients with a tumor around the knee. In addition to walking at a preferred speed, the patients might be sometimes required to walk fast in daily life (e.g., schooling and working) because the major types of bone tumors often occur in adolescence and young adults. Therefore, recovering the ability to walk fast would increase the quality of life of these patients. To clarify which parts of the lower limb are exerted while walking fast, we investigated the kinematic and kinetic changes during fast walking in patients who underwent endoprosthetic knee replacement after bone tumor resection. Laboratory-based gait analysis was performed on eight patients who had undergone endoprosthetic knee replacement following resection of a tumor around the knee. Patients walked at a preferred and faster speed, and the gait parameters were compared between the two walking speeds for each leg. To increase walking speed, patients tended to rely on the bilateral hip, ankle, and contralateral knee to generate additional power. Kinetic analysis showed that involved-side vertical body support was not significantly increased during late stance to increase walking speed, which was associated with a small increase in ankle plantarflexion moment and concentric power. These results suggest to patients after knee reconstruction how to effectively increase their walking speed or redistribute the mechanical load on the muscles and joints to prevent excessive stress on the lower limbs.
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Artroplastia de Reemplazo de Rodilla , Neoplasias Óseas/cirugía , Deambulación Dependiente/fisiología , Neoplasias Femorales/cirugía , Marcha/fisiología , Prótesis de la Rodilla , Tibia/cirugía , Adulto , Articulación del Tobillo/fisiopatología , Fenómenos Biomecánicos , Neoplasias Óseas/fisiopatología , Estudios Transversales , Femenino , Neoplasias Femorales/fisiopatología , Articulación de la Cadera/fisiopatología , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Calidad de Vida , Caminata/fisiologíaRESUMEN
OBJECTIVE: To investigate the effects of an automated stride assistance device that assists hip joint flexion and extension movement in energy expenditure during walking in healthy young adults using an expired gas method. DESIGN: Prospective, single-group design to compare the differences of energy expenditure between 2 assistive conditions. SETTING: Laboratory. PARTICIPANTS: Healthy volunteers (N=10) aged 21 to 32 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Oxygen consumption per unit time (VËo2) cost (ml·kg(-1)·m(-1)), and heart rate (beats/min) were measured in 2 assistive conditions (with 3-Nm hip motion assistance and without assistance) and at 2 walking speeds (comfortable walking speed [CWS] and maximum walking speed [MWS]). RESULTS: There were no significant differences in walking speed between the with- and without-assistance conditions at either the CWS or MWS. The VËo2 cost and heart rate were significantly reduced in the with-assistance condition compared with the without-assistance condition, at both the CWS and MWS. The reduction in the VËo2 cost during the with-assistance condition, relative to the without-assistance condition, was 7.06% at the CWS and 10.52% at the MWS. CONCLUSIONS: The automated stride assistance device is useful for reducing energy expenditure during walking in healthy adults. Further studies are warranted to investigate if this device provides substantial help to individuals with impaired mobility as a result of strength deficits.
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Deambulación Dependiente/fisiología , Metabolismo Energético/fisiología , Equipos y Suministros , Marcha/fisiología , Articulación de la Cadera/fisiología , Caminata/fisiología , Adulto , Prueba de Esfuerzo , Femenino , Voluntarios Sanos , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Consumo de Oxígeno/fisiología , Adulto JovenRESUMEN
PURPOSE: To investigate energy expenditure of people with multiple sclerosis (MS) during everyday activities. METHODS: Fifteen healthy controls, 19 people with MS who used at most a stick to walk outdoors (MS-A), and 11 people with MS who used bilateral support for gait (MS-B) completed scripted everyday activities. A portable indirect calorimetry unit calculated energy expenditure. Steps were counted from video. RESULTS: There was no significant difference in kcal between the three groups (ANOVA: F(2, 42) = 2.877, p = 0.067). There was a significant difference in steps: F(2, 42) = 17.93, p < 0.001. (Controls-MS-A 470.5, 95% CI 85.2, 855.7, Control-MS-B 1091.3, 95% CI 648.5, 1534.1, MS-A-MS-B 620.8, 95% CI 198.2, 1043.4.) Energy cost of movement was estimated by dividing kcal by steps. The Kruskal-Wallis analysis found significant difference for total (x(2 )= 11.726, df2, p = 0.003), Walking (x(2 )= 9.01, p = 0.011), Stairs (x(2 )= 16.436, 2, p < 0.001). Post-hoc analysis revealed significant differences between MS-B group and control and MS-A groups. CONCLUSIONS: People with MS do not use more energy than healthy controls during everyday activities at a self-selected pace. People with MS take significantly fewer steps during activities of daily living's. People who use bilateral support for gait have greater energy cost per step for walking and stairs activities. Implications for Rehabilitation This study found that the energy cost of movement is greater for people with MS with significant disability. Energy expenditure is an important consideration when prescribing physical activity and structured exercise for people with disability. It may be more appropriate to have energy, rather than movement, targets when prescribing physical activity for this population.
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Deambulación Dependiente/fisiología , Metabolismo Energético , Marcha/fisiología , Limitación de la Movilidad , Esclerosis Múltiple , Actividades Cotidianas , Adulto , Calorimetría Indirecta/métodos , Estudios Transversales , Femenino , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Actividad Motora/fisiología , Esclerosis Múltiple/metabolismo , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/rehabilitaciónRESUMEN
Walker devices are often prescribed incorrectly to patients, leading to the increase of dissatisfaction and occurrence of several problems, such as, discomfort and pain. Thus, it is necessary to objectively evaluate the effects that assisted gait can have on the gait patterns of walker users, comparatively to a non-assisted gait. A gait analysis, focusing on spatiotemporal and kinematics parameters, will be issued for this purpose. However, gait analysis yields redundant information that often is difficult to interpret. This study addresses the problem of selecting the most relevant gait features required to differentiate between assisted and non-assisted gait. For that purpose, it is presented an efficient approach that combines evolutionary techniques, based on genetic algorithms, and support vector machine algorithms, to discriminate differences between assisted and non-assisted gait with a walker with forearm supports. For comparison purposes, other classification algorithms are verified. Results with healthy subjects show that the main differences are characterized by balance and joints excursion in the sagittal plane. These results, confirmed by clinical evidence, allow concluding that this technique is an efficient feature selection approach.
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Algoritmos , Deambulación Dependiente/fisiología , Marcha/fisiología , Máquina de Vectores de Soporte , Andadores , Adulto , Fenómenos Biomecánicos , Biología Computacional , Deambulación Dependiente/estadística & datos numéricos , Humanos , Modelos Biológicos , Rehabilitación/instrumentación , Rehabilitación/estadística & datos numéricos , Grabación en Video , Adulto JovenRESUMEN
OBJECTIVE: To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables. DESIGN: Cross-sectional study. SETTING: Outpatient department of a rehabilitation center. PARTICIPANTS: Persons with an LLA (N=155; mean age ± SD, 64.1 ± 11.2y; 73% men). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The necessity to climb stairs was assessed with the Prosthetic Profile of the Amputee. Several indicators of the ability to climb stairs were assessed including: (1) independence in climbing stairs with a handrail and (2) without a handrail, according to the Locomotor Capabilities Index; (3) numbers of floors actually climbed, according to a rating scale; and (4) limitations in climbing stairs, according to the Climbing Stairs Questionnaire (range, 0-100, with higher scores indicating less limitations). Multivariate logistic regression analysis was used to investigate the associations between the ability to climb stairs and personal and clinical variables. RESULTS: Of the participants, 47% had to climb stairs. The ability to climb stairs was: (1) 62% independently climbed stairs with a handrail and (2) 21% without a handrail; (3) 32% didn't climb any stairs, 34% climbed half a floor or 1 floor, and 34% climbed ≥ 2 floors; (4) the median sum score (interquartile range) of the Climbing Stairs Questionnaire was 38 (19-63), indicating marked limitations. Older participants and women were less able to climb stairs with and without a handrail. CONCLUSIONS: A considerable number of persons with an LLA have to climb stairs in their home environment. Many of them, especially older participants and women, are particularly hampered in their ability to climb stairs.
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Atención Ambulatoria , Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Deambulación Dependiente/fisiología , Extremidad Inferior , Actividad Motora/fisiología , Actividades Cotidianas , Anciano , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de SaludRESUMEN
OBJECTIVE: To compare a seal-in liner with the common suction socket with regards to patient satisfaction and problems experienced with the prosthesis. DESIGN: Retrospective survey. SETTING: A medical and engineering research center and a department of biomechanical engineering. PARTICIPANTS: Men (N=90) with traumatic transfemoral amputation who used both suspension systems participated in the study. INTERVENTION: Two prosthetic suspension systems: a seal-in liner and common suction socket. MAIN OUTCOME MEASURES: Two questionnaires were completed by each subject to evaluate their satisfaction and problems experienced with the 2 suspension systems. Satisfaction and problems with the prosthetic suspension systems were analyzed in terms of fitting, donning and doffing, sitting, walking, stair negotiation, appearance, sweating, wounds, pain, irritation, pistoning, edema, smell, sound, and durability. RESULTS: The study revealed that the respondents were more satisfied with a seal-in liner with regards to fitting, sitting, and donning and doffing. Overall satisfaction increased with the use of a seal-in liner compared with the suction socket (P<.05). However, satisfaction with the prosthesis showed no significant differences in terms of walking (flat and uneven surfaces), appearance, and stair negotiation. Furthermore, problems experienced differed significantly between the 2 suspension systems (P<.05). Sweating, wounds, pain, irritation, pistoning, edema, smell, and sound were less problematic with the use of a seal-in liner, whereas durability was significantly better with the suction socket. CONCLUSIONS: The results of the survey suggest that satisfaction and problems with prosthetic suspension in persons with transfemoral amputation can be improved with a seal-in liner compared with the suction socket, provided that the durability of the liner is enhanced.
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Muñones de Amputación , Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Fémur , Satisfacción del Paciente , Diseño de Prótesis , Adulto , Miembros Artificiales/efectos adversos , Deambulación Dependiente/fisiología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis/efectos adversos , Ajuste de Prótesis , Estudios RetrospectivosRESUMEN
Gait abnormalities are a hallmark of Parkinson's disease (PD) and contribute to fall risk. Therapy and exercise are often encouraged to increase mobility and decrease falls. As disease symptoms progress, assistive devices are often prescribed. There are no guidelines for choosing appropriate ambulatory devices. This unique study systematically examined the impact of a broad range of assistive devices on gait measures during walking in both a straight path and around obstacles in individuals with PD. Quantitative gait measures, including velocity, stride length, percent swing and double support time, and coefficients of variation were assessed in 27 individuals with PD with or without one of six different devices including canes, standard and wheeled walkers (two, four or U-Step). Data were collected using the GAITRite and on a figure-of-eight course. All devices, with the exception of four-wheeled and U-Step walkers significantly decreased gait velocity. The four-wheeled walker resulted in less variability in gait measures and had less impact on spontaneous unassisted gait patterns. The U-Step walker exhibited the highest variability across all parameters followed by the two-wheeled and standard walkers. Higher variability has been correlated with increased falls. Though subjects performed better on a figure-of-eight course using either the four-wheeled or the U-Step walker, the four-wheeled walker resulted in the most consistent improvement in overall gait variables. Laser light use on a U-Step walker did not improve gait measures or safety in figure-of-eight compared to other devices. Of the devices tested, the four-wheeled-walker offered the most consistent advantages for improving mobility and safety.
Asunto(s)
Bastones , Deambulación Dependiente/fisiología , Marcha , Enfermedad de Parkinson/rehabilitación , Andadores , Accidentes por Caídas/prevención & control , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dispositivos de Autoayuda , Resultado del TratamientoRESUMEN
Normally, when the patient's functional recovery involves partial weight-bearing aided walking using forearm crutches, it is not possible to control the amount of weight-bearing objectively that the individuals carry out and its progression. This leads to significant errors in accuracy and, consequently, complications and after effects in pathologies. To compensate for this deficiency, we have set out to design and validate a measurement system and a computerized record of the loads exerted on Canadian crutches in aided walking as well as incorporating a mechanism for acoustic and visual biofeedback that will inform the subject if said charges are correct, so that they are able correct their errors and avoid problems in their recovery. We analyzed the validity and reliability of the system through a concordance study with the AMTI OR6-7-2000 force plate, extensively validated previously, while finding a correlation coefficient of 0.99 with a significance (p<0.001). We have designed and developed a measurement system with a computerized record, analysis and wireless graphical display of real-time data, incorporating a mechanism for acoustic and visual biofeedback to measure the loads exerted on forearm crutches during aided walking. The device, called "GCH System 1.0" is a reliable and valid instrument.
Asunto(s)
Muletas , Deambulación Dependiente/fisiología , Antebrazo/fisiología , Marcha , Enfermedades Musculoesqueléticas/rehabilitación , Diseño de Software , Soporte de Peso/fisiología , Adolescente , Adulto , Diseño de Equipo , Retroalimentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. ≥ 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.
Asunto(s)
Evaluación de la Discapacidad , Personas con Discapacidad , Escolaridad , Accidente Cerebrovascular/fisiopatología , Adulto , Factores de Edad , Anciano , Deambulación Dependiente/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Recuperación de la Función , Factores de Riesgo , Accidente Cerebrovascular/patología , SobrevivientesRESUMEN
We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. > 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.
Foi avaliada a dependência funcional em sobreviventes de acidente vascular cerebral (AVC) do Estudo da Mortalidade e Morbidade do Acidente Vascular Cerebral, utilizando a Escala de Rankin. De 355 sobreviventes com AVC isquêmico (idade média de 67,9 anos), 40% tinham dependência funcional em 28 dias e 34,4% em 6 meses. Os principais indicadores de dependência física foram identificados em 28 dias, e eram: baixa escolaridade (analfabetos vs. > 8 anos de educação, RC = 3,7; IC95%: 1,60-8,54) e localização do AVC (infarto circulação total anterior, RC = 16,9; IC95%: 2,93-97,49). Baixo nível educacional e insulto cerebral isquêmico influenciaram o grau de dependência funcional nesses sobreviventes de AVC. Nossos achados reforçam a necessidade de desenvolvimento de estratégias para reabilitação de pacientes com AVC e formulação de estratégias específicas de atenção e tratamento para essas pessoas, especialmente na população com baixo nível socioeconômico.