Social dynamics of supported walking in 11-month-old infants.

Before infants walk independently, they move upright with support by holding caregivers' hands, pushing a wheeled walker, and "cruising" along walls or furniture. To what extent do caregivers and infants engage in these activities and do these experiences with supported walking relate to independent walking status? To address these questions, we assessed supported walking in 50 11-month-olds and their mothers in the context of everyday routines. For each bout of supported walking, coders scored the type of support, frequency of supported bouts, and the number of steps infants took per bout. Mothers tracked onset ages for independent walking prospectively, and researchers verified infants' walking skill using a standardized task. Infants who produced more child-controlled supported walking achieved independent walking earlier than infants who produced less child-controlled supported walking. But, supported walking experience did not predict proficiency of independent walking, suggesting that the two types of locomotion are distinct. These data highlight the role of experience of locomotor behaviors and indicate that not all experience is equally effective.

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults.

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

Manifestations of walking fatigability in people with multiple sclerosis based on gait quality and distance walked during the six minutes walking test.

BACKGROUND: Distance walking fatigability (DWF) in people with multiple sclerosis (pwMS) is defined as a decrease in the distance walking over time. However, declines in gait quality (i.e., gait quality fatigability- GQF) may occur independently or alongside DWF. OBJECTIVE: i) to investigate how walking fatigability manifests and its prevalence in pwMS; ii) to describe the temporal pattern of the changes of specific gait characteristics during the 6-minute walking test (6MWT) METHODS: Eighty-eight pwMS (EDSS 4[0-6.5], 49[21-70] years) and 47 healthy controls (HC- 46[25-60] years) performed the 6MWT wearing inertial measurement units. Gait characteristics (stride length, sensor-based gait speed, cadence, double support, step duration, stance phase, step duration asymmetry, step duration variability, foot-strike, toe-off, and leg circumduction) and walking distance were recorded in 1-minute intervals. A fatigability index was calculated by comparing the last and first minute of the 6MWT to identify abnormal worsening based on cutoff scores. The manifestation of walking fatigability was counted. The temporal pattern of worsening of gait characteristics during the 6MWT was examined in pwMS exceeding the cutoff values, compared to pwMS without abnormal changes and HC, using a two-way ANOVA (group vs. minutes) RESULTS: Thirty-five pwMS presented both DWF and GQF, 2 presented isolated DWF, 27 presented isolated GQF, and 24 presented non-walking fatigability. PwMS having GQF presented worsening in gait characteristics (cadence, step duration, step duration variability, or toe-off angle) from minute 2 onwards of the 6MWT, while HCs and pwMS without abnormal changes stabilized gait from minute 2 towards the end of the 6MWT. CONCLUSION: Walking fatigability in pwMS manifests not only as a decrease in walking distance but also as changes in gait quality. Understanding changes in gait characteristics during walking can help tailor rehabilitation interventions.

Strategies for unplanned gait termination at comfortable and fast walking speeds in children with cerebral palsy.

Collision avoidance while walking is necessary for safe living, and faster walking speeds tend to increase collision risk. However, gait termination strategies for patients with cerebral palsy (CP), from comfortable to faster speed, remain unexplored. This study aimed to analyze these strategies in children with CP compared to typically developing (TD) children at two different speeds. Study participants included 10 children with CP (mean age, 12.5; five females; mean height, 147.8 cm; mean weight, 41.7 kg) and 10 TD children (mean age, 11.4; nine females; mean height, 142.0 cm; mean weight, 38.1 kg). Effects of walking speed on spatial, force, and temporal parameters were assessed at 100 % (WS1) and 125 % (WS2) speeds of comfortable walking. The TD group exerted a more pronounced braking force at the first step after the stop line appeared on the floor until the contralateral step at both WS1 (P = 0.006) and WS2 (P = 0.019); however, the CP group exerted a more potent force after the second step (WS1: P = 0.026, WS2: P = 0.023) in the anterior-posterior (AP) direction. Additionally, an increase in the center of mass (COM)-center of pressure (COP) divergence in the AP direction (P = 0.032), which decreased in the mediolateral (ML) direction (P = 0.036) at faster walking speeds, influenced the kinetic characteristics of the CP group from WS1 to WS2. The complex adaptations, such as unique braking forces and changes in the COM-COP divergence, suggest that gait interventions should consider the distinctive forces and adopt dynamic balancing strategies to avoid collisions during walking.

The effect of motor dual-task training on gait and mobility performances in children with intellectual disabilities.

The study investigated the impact of motor dual-task training on gait and mobility in children with intellectual disabilities. Performance was assessed using the Timed Up and Go Test (TUGT) and the 10-Meter Walking Test (TMWT) before and after an 8-week training period, with participants divided into a Trained Group (n=12) and a Control Group (n=14). Results indicated that, across both groups and regardless of session, TUGT and TMWT scores were significantly higher (p < 0.001) in the motor dual-task condition compared to the single-task condition. Post-training, TUGT scores significantly decreased (p < 0.05) in the single-task condition. The Trained Group showed significant improvements in second motor-task performance on both TUGT (p < 0.05) and TMWT (p < 0.001) under dual-task conditions, while the Control Group showed no change. The study demonstrated the effectiveness of motor dual-task training in enhancing mobility in children with intellectual disabilities.

Enhancing autumn greenway walking experience: Exploring the combined effects of noise and thermal environment.

The evaluation of outdoor green spaces is influenced by diverse sensory perceptions. Traffic noise and thermal conditions significantly impact greenway-walking satisfaction; their optimization is vital for improving user experience and encouraging outdoor engagement. The study examines a typical Beijing greenway during autumn, focusing on strategies to enhance the walking experience under the combined effects of noise and thermal environments through mobile measurements and surveys. The results show that: 1) The interplay between noise and thermal factors varies depending on the walking state. Upon arrival, an increase in noise significantly worsens thermal comfort; higher sound levels intensify warm thermal sensations, though this effect is not consciously perceived. Upon departure, the effect of noise on thermal perception is not obvious. In both walking states, thermal sensation significantly affects subjective noise perception, yet the trends of influence differ. Subjective noise loudness increases as thermal comfort worsens, showing significant correlation only upon departure. 2) During autumn greenway walks, acoustic factors exert a greater impact on Overall Environmental Satisfaction (OES), with subjective noise loudness being more influential than noise level, followed by air temperature (Ta). Greater noise decreases OES, while OES increases initially with Ta and then decreases. The integrated effects of noise-thermal factors on OES show significant changes. 3) To enhance the autumn greenway-walking experience, the advised parameters are A-weighted Sound Level (ASL) ≤ 59.12 dBA and 15.17 °C ≤ Ta ≤ 18.75 °C. Finally, three design strategies are proposed: reducing subjective noise loudness, differentiating design based on walking status and balancing acoustic-thermal perceptual preferences.

Characteristics of upper limb joint mechanics with increased cane dependence during walking.

[Purpose] This study investigated the effects of differences in cane dependence on the mechanical work at the shoulder, elbow, and wrist joints during walking. [Participants and Methods] Fifteen volunteers participated in this study (mean ± standard deviation [SD] age: 24.9 ± 2.7 years, height: 1.73 ± 0.04 m, and body mass: 68.5 ± 8.9 kg). The participants walked under three conditions: (1) without a cane, (2) with a cane at 10% body weight (BW), and (3) with a cane at 20% BW. The shoulder, elbow, and wrist joint work was calculated to evaluate the mechanical load. [Results] The results indicated a significant interaction between load conditions and positive joint work, as well as between load conditions and negative joint work. The positive work in the shoulder and elbow joints significantly increased in the 20% BW condition compared to that in the 10% BW condition. [Conclusion] Increased cane dependence did not uniformly increase the positive and negative work of the shoulder, elbow, and wrist joints. Increased cane dependence during walking increases energy generation in the shoulder and elbow joints, which can result in adverse musculoskeletal strain on the shoulder and elbow joints.

Multidisciplinary Delphi Panel on Rehabilitation Approaches and Unmet Needs for Chronic Stroke Walking Impairment and the Role of Rhythmic Auditory Stimulation.

INTRODUCTION: Walking or gait impairment is a common consequence of stroke that persists into the chronic phase of recovery for many stroke survivors. The goals of this work were to obtain consensus from a multidisciplinary panel on current practice patterns and treatment options for walking impairment after stroke, to better understand the unmet needs for rehabilitation in the chronic phase of recovery and to explore opportunities to address them, and to discuss the potential role of rhythmic auditory stimulation (RAS) in gait rehabilitation. METHODS: A panel of eight experts specializing in neurology, physical therapy, and physiatry participated in this three-part, modified Delphi study. Survey 1 focused on gathering information to develop statements that were discussed and polled during Survey 2 (interactive session), after which revised and new statements were polled in Survey 3. Consensus was defined as ≥75% (6/8 of panelists) agreement or disagreement with a statement. RESULTS: Consensus agreement was ultimately reached on all 24 statements created and polled during this process. The panelists agreed that individuals with gait or walking impairment in the chronic phase of stroke recovery can achieve meaningful improvement in walking by utilizing various evidence-based interventions. Barriers to treatment included cost, access, participation in long-term treatment, and safety. Consensus was achieved for interventions that have the following features challenging, personalized, accessible, and engaging. Improvement of gait speed and quality, durability of effect, safety, affordability, and ability for home or community use also emerged as important treatment features. In addition to conventional treatments (e.g., physical therapy, including mobility-task training and walking/exercise therapy), RAS was recognized as a potentially valuable treatment modality.  Discussion: This panel highlighted limitations of current treatments and opportunities to improve access, participation, and outcomes through a consideration of newer treatment strategies and patient/healthcare provider education and engagement.

Graded Progressive Home-Based Resistance Combined with Aerobic Exercise in Community-Dwelling Older Adults with Sarcopenia: A Randomized Controlled Trial.

Purpose: This randomized parallel controlled trial aimed to determine the effectiveness of graded progressive home-based resistance combined with aerobic exercise in improving physical fitness in community-dwelling older adults with sarcopenia. Patients and Methods: Community-dwelling older adults (≥60 years) with sarcopenia were randomly assigned to the intervention group (IG), receiving 12 weeks of graded progressive home-based resistance and aerobic exercise training, and the control group (CG), maintaining lifestyle unchanged. The primary outcomes were knee extensor muscle strength and the six-minute walk distance (6MWD). Intention-to-treat analysis was applied to the data from all participants in the CG and IG. Post-intervention differences between the intervention and control groups were determined using a generalized estimated equation model with pre-values adjusted. Results: Data from all the participants in the IG (n=41) and CG (n=45) were analyzed. After the intervention, knee extensor muscle strength (95% CI: 0.140-3.460, P=0.036), 6MWD (95% CI: 35.350-80.010, P<0.001), flexor muscle strength and the results of 30s bicep curls, 30s chair stand, the chair sit and reach test and back stretch test in the IG were larger and value of the timed up-and-go test was smaller than those in the CG (P<0.05). The body composition, quality of life and their changes showed no group differences. The attendance rates were 82.9% and 85.4% for resistance and aerobic exercise, respectively. Conclusion: The 12-week graded progressive home-based resistance and aerobic exercise intervention improved muscle strength, balance, flexibility, and cardiorespiratory fitness in community-dwelling older adults with sarcopenia, whereas body composition and quality of life remained unchanged. The research was approved by the Ethics Committee of Soochow University (ECSU-2019000161) and registered at the Chinese Clinical Trial Registry (ChiCTR1900027960, http://www.chictr.org.cn/showproj.aspx?proj=45968).

Associations between dual-task walking and cognitive impairment in people attending a cognitive diagnostic clinic.

OBJECTIVES: Dual-task walking performance is an early marker of dementia. However, there is uncertainty about which measure of the dual-task test is a better marker. The objective of this study was to determine which dual-task measure best differentiates between normal cognition, mild cognitive impairment (MCI) and dementia. METHODS: Participants (n = 116) were aged ≥60 years attending a cognitive clinic in Melbourne, Australia. Single- and dual-task gait speed were obtained using a 16 metre distance and stopwatch. The cognitive task involved reciting alternate letters of the alphabet sitting and walking. Dual-task interference in gait and cognition was calculated as: single-task-dual-task/single task × 100 and summed to obtain total interference. Multiple linear regression was used to determine differences in single and dual-task measures between those with no cognitive impairment (n = 11), MCI (n = 54) and dementia (n = 51). RESULTS: The mean age of the sample was 76.9 (SD 6.4) years and 48.3% (n = 56) were female. Compared to those with dementia: (a) those with MCI had a higher dual-task letter rate and lower cognitive and total interference (all indicate better performance) (p < .05) and (b) those with no cognitive impairment had a higher single- and dual-task letter rate (both indicate better performance) (p < .05). There were no differences between those with no cognitive impairment and those with MCI (all p > .05). CONCLUSIONS: In a cognitive clinic, measurement during dual-task walking differentiated those with dementia from those with MCI or no cognitive impairment. However, differences appear to be driven by performance on the cognitive, rather than the gait task.

Auditory-motor synchronization in developmental coordination disorder: Effects on interlimb coordination during walking and running.

Developmental coordination disorder (DCD) presents challenges in motor control. DCD affects tasks such as walking and running and is characterized by poor interlimb coordination and increased spatiotemporal variability compared to typically developing children (TDC). While auditory rhythm synchronization has shown to have benefits for gait performance in adults, its impact on children with DCD during walking and running remains unclear. This study investigated auditory-motor synchronization and interlimb coordination during walking and running in children with and without DCD. Twenty-one DCD and 23 TDC participants aged 8-12 years walked and ran to two different auditory metronomes (discrete and continuous). Synchronization consistency was the primary outcome, with interlimb coordination and spatiotemporal variability as secondary outcomes. Results showed that children with DCD exhibited significantly lower synchronization consistency than TDC, particularly during running. The metronome structure did not influence synchronization ability. Additionally, interlimb coordination differed significantly between DCD and TDC during running and was not impacted by auditory-motor synchronization. Spatiotemporal variability was higher in DCD during both walking and running than in TDC, and accentuated during running. Variability of cadence was influenced by the use of continuous metronomes, which may offer potential benefits in reducing cadence variability.

Fine-grained descending control of steering in walking Drosophila.

Locomotion involves rhythmic limb movement patterns that originate in circuits outside the brain. Purposeful locomotion requires descending commands from the brain, but we do not understand how these commands are structured. Here, we investigate this issue, focusing on the control of steering in walking Drosophila. First, we describe different limb "gestures" associated with different steering maneuvers. Next, we identify a set of descending neurons whose activity predicts steering. Focusing on two descending cell types downstream of distinct brain networks, we show that they evoke specific limb gestures: one lengthens strides on the outside of a turn, while the other attenuates strides on the inside of a turn. Our results suggest that a single descending neuron can have opposite effects during different locomotor rhythm phases, and we identify networks positioned to implement this phase-specific gating. Together, our results show how purposeful locomotion emerges from specific, coordinated modulations of low-level patterns.

Association between grip strength, walking pace and incident peripheral artery disease: A prospective study of 430,886 UK biobank participants.

Background and aims: Patients with peripheral artery disease (PAD) presented overall muscle weakness and reduced physical performance. Previous study focused on the impact of muscle weakness on outcomes of established PAD, however the relationship between compromised muscle function and incident PAD remained unclear. Methods: A prospective study involving 430,886 participants aged 40-69 y from UK biobank was conducted. The main outcome was incident PAD. Grip strength and walking pace were used as indicators for muscle function. Grip strength was measured using a Jamar J00105 hydraulic hand dynamometer, while walking pace was self-reported by the participants. Cox proportional hazard models were employed to investigate the relationship between grip strength, walking pace, and incident PAD. Results: A total of 430,886 individuals were included in the final analysis. The mean age of the participants were 56.44 years, and 55.3 % were female. Over a median follow-up period of 13.81 years, 5,661 participants developed PAD. Higher grip strength, whether absolute or relative, exhibited a dose-dependent inverse association with incident PAD. Each 1 kg increment in absolute grip strength and each 0.01 kg/kg increase in relative grip strength were associated with reduced PAD risk by 2 % (HR: 0.98; 95 % CI [0.97-0.98]) and 83 % (HR: 0.17; 95 % CI [0.13-0.23]), respectively. Slow walking pace significantly correlated with increased PAD risk, while brisk walking pace was associated with decreased PAD risk. Conclusion: Absolute grip strength, relative grip strength and walking pace were inversely associated with the risk of incident PAD.

'Watkins' & 'Watkins2.0': Smart phone applications (Apps) for gait-assessment in normal pressure hydrocephalus and decompensated long-standing overt ventriculomegaly.

OBJECTIVE: Gait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-m-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team. METHODS: 10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve. RESULTS: As compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1-3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25-0.50 m. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1-2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 m. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC > 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals. CONCLUSION: 'Watkins' and 'Watkins2.0' are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance.

Long-term oxygen therapy in precapillary pulmonary hypertension - SOPHA study.

Current guidelines recommend oxygen (O2) supplementation in patients with pulmonary hypertension (PH), despite scarce data on long-term O2 therapy (LTOT). The aim of this prospective, randomized, controlled trial was to investigate the effect of LTOT in patients with precapillary PH on exercise capacity, clinical parameters and hemodynamics. Patients with precapillary PH under stable therapy and O2 desaturations at rest and/or during exercise were randomized to receive LTOT (≥ 16 h/day) or no O2 (control group) for 12 weeks. The control group was offered LTOT after 12 weeks. The primary endpoint changes of 6-minute walking distance (6MWD) from baseline to 12 weeks was hierarchically tested: (1) pre-post primary and secondary intervention (2) intervention vs. control group. Secondary endpoints included changes in clinical parameters. Twenty patients were randomized (women n = 14, age 67 ± 11.4 years, mean pulmonary arterial pressure 39.7 ± 12.5 mmHg, 70% functional class III). 6MWD significantly improved by 42.2 ± 34.20 m (p = 0.003) within 12 weeks LTOT. The intervention group significantly improved in 6MWD (38.9 ± 33.87 m) compared to the control group (- 12.3 ± 21.83 m, p = 0.015). No consistent between-group differences in other parameters were found. LTOT was well tolerated and led to significant improvement of 6MWD. The effect of LTOT should be investigated in larger controlled-trials.

Characterizing the Longitudinal Impact of Backward Locomotor Treadmill Training on Walking and Balance Outcomes in Chronic Stroke Survivors: A Randomized Single Center Clinical Trial.

Background and Purpose: Walking and balance impairments after stroke are a global health concern, causing significant morbidity and mortality. However, effective strategies for achieving meaningful recovery in the chronic stages are limited. Backward locomotor treadmill training (BLTT) is a novel walking rehabilitation protocol that is safe, feasible, and likely beneficial in stroke survivors; however, its efficacy has not been tested. This single-center, randomized, assessor-blind clinical trial aims to test the preliminary efficacy of BLTT compared to forward locomotor treadmill training (FLTT) on walking speed, symmetry, and postural stability. Methods: Forty stroke survivors [BLTT (N=19), FLTT (N=21); mean age= 56.3 ± 8.6 years; 53% Female; 30% Non-Hispanic Black] with mild-moderate walking impairment were enrolled. Participants underwent nine 30-minute BLTT or FLTT sessions over three weeks. The primary outcome was the mean change in the 10-meter walk test (10 MWT) at 24 hours post-training (24 hr POST). Secondary outcome measures were changes in spatiotemporal walking symmetry and postural stability during quiet standing at 24 hr POST. Retention was explored at Days 30- and 90 POST. Results: We report clinically meaningful (≥ 0.16 m/s) improvements in overground walking speed at 24 hr POST, with retention up to Day 90 POST with BLTT and FLTT. However, contrary to our working hypothesis, no between-group differences in walking speed were observed. Nonetheless, we found that BLTT resulted in offline improvements in spatial symmetry and retention of subcomponents of the modified clinical test of sensory interaction on balance (mCTSIB), including the testing of proprio-vestibular integration up to Day 30 POST. Conclusion: Among chronic stroke patients with mild-moderate walking impairment, BLTT and FLTT both resulted in long-lasting and clinically meaningful improvement in walking speed. However, preliminary findings suggest that BLTT may better comprehensively target walking asymmetry and sensory systems processing and integration.

Right visual field advantage in orientation discrimination is influenced by biased suppression.

Visual input is not equally processed over space. In recent years, a right visual field advantage during free walking and standing in orientation discrimination and contrast detection task was reported. The current study investigated the underlying mechanism of the previously reported right visual field advantage. It particularly tested if the advantage is driven by a stronger suppression of distracting input from the left visual field or improved processing of targets from the right visual field. Combing behavioural and electrophysiological measurements in a mobile EEG and augmented reality setup, human participants (n = 30) in a standing and a walking condition performed a line orientation discrimination task with stimulus eccentricity and distractor status being manipulated. The right visual field advantage, as demonstrated in accuracy and reaction time, was influenced by the distractor status. Specifically, the right visual field advantage was only observed when the target had an incongruent line orientation with the distractor. Neural data further showed that the right visual field advantage was paralleled by a strong modulation of neural activity in the right hemisphere (i.e. contralateral to the distractor). A significant positive correlation between this right hemispheric event related potential (ERP) and behavioural measures (accuracy and reaction time) was found exclusively for trials in which a target was presented on the right and an incongruent distractor was presented on the left. The right hemispheric ERP component further predicted the strength of the right visual field advantage. Notably, the lateralised brain activity and the right visual field advantage were both independent of stimulus eccentricity and the movement state of participants. Overall, our findings suggest an important role of spatially biased suppression of left distracting input in the right visual field advantage as found in orientation discrimination.

The impact of mobility limitations on geriatric rehabilitation outcomes: Positive effects of resistance exercise training (RESORT).

BACKGROUND: Regaining walking ability is a key target in geriatric rehabilitation. This study evaluated the prevalence of walking ability at (pre-)admission and related clinical characteristics in a cohort of geriatric rehabilitation inpatients; in inpatients without walking ability, feasibility and effectiveness of progressive resistance exercise training (PRT) were assessed. METHODS: Inpatients within RESORT, an observational, longitudinal cohort of geriatric rehabilitation inpatients, were stratified in those with and without ability to walk independently (defined by Functional Ambulation Classification (FAC) score ≤ 2) at admission; further subdivision was performed by pre-admission walking ability. Clinical characteristics at admission, length of stay, and changes in physical and functional performance throughout admission were compared depending on (pre-)admission walking ability. Feasibility (relative number of PRT sessions given and dropout rate) and effectiveness [change in Short Physical Performance Battery, FAC, independence in (instrumental) activities of daily living (ADL/IADL)] of PRT (n = 11) in a subset of inpatients without ability to walk independently at admission (able to walk pre-admission) were investigated compared with usual care (n = 11) (LIFT-UP study). RESULTS: Out of 710 inpatients (median age 83.5 years; 58.0% female), 52.2% were not able to walk independently at admission, and 7.6% were not able to walk pre-admission. Inpatients who were not able to walk independently at admission, had a longer length of stay, higher prevalence of cognitive impairment and frailty and malnutrition risk scores, and a lower improvement in independence in (I)ADL compared with inpatients who were able to walk at both admission and pre-admission. In LIFT-UP, the relative median number of PRT sessions given compared with the protocol (twice per weekday) was 11 out of 44. There were no dropouts. PRT improved FAC (P = 0.028) and ADL (P = 0.034) compared with usual care. CONCLUSIONS: High prevalence of inpatients who are not able to walk independently and its negative impact on independence in (I)ADL during geriatric rehabilitation highlights the importance of tailored interventions such as PRT, which resulted in improvement in FAC and ADL.

Dizziness and impaired walking balance in aging patients during chemotherapy.

INTRODUCTION: Older adults are at risk of adverse effects during chemotherapy including nausea and fatigue, but many also suffer from dizziness and peripheral neuropathy. This may lead to balance and walking impairments and increased risk of falls and affect health-related quality of life. Moreover, these symptoms are often underreported with inadequate awareness among health professionals leading to deficient focus on the need for targeted assessment and rehabilitation. We aimed to examine the prevalence of dizziness, impaired walking balance, and neuropathy and falls in older adults ≥65 years with gastrointestinal cancer receiving chemotherapy and the associations between these symptoms. Further, we aimed to examine the quantity of patients reporting these symptoms to the oncologist. MATERIALS AND METHODS: This is a cross-sectional study among patients ≥65 years with gastrointestinal cancers who have completed three or more series of chemotherapy. The prevalence of dizziness, impaired walking balance, neuropathy, and reporting of these adverse effects was examined through structured questionnaires. RESULTS: Of two hundred patients (57 % male, mean age 74.4 years) the prevalence of dizziness was 54 % and the prevalence of patients experiencing impaired walking balance was 48 %. Symptoms of neuropathy was present in 32 % of patients and 11 % experienced falls during chemotherapy. Symptoms of neuropathy was associated with experiencing dizziness: odds ratio (OR) 1.98 (95 % confidence interval [CI]: 1.06; 3.71) and impaired balance: OR 3.61 (95 % CI: 1.87; 6.96). Less than half the patients (48 %) told the oncologist about these symptoms. DISCUSSION: Dizziness and impaired walking balance during chemotherapy are underreported yet profound symptoms among older patients with cancer. Dizziness and impaired balance should be systematically assessed during chemotherapy among older patients.

Effect of light walking combined with arthroscopic surgery on bone mineral density in patients with foot and ankle osteoarthritis.

ObjectiveTo observe the effect of light walking combined with arthroscopic surgery on the efficacy and Bone Mineral Density (BMD) of patients with ankle arthritis. Methods 180 patients with ankle arthritis were retrospectively selected, who were divided into a control group (Group A) and an experimental group (Group B) according to treatment methods, with 90 patients in each group. Group A was treated with conventional open surgery and Group B was treated with light walking combined with arthroscopic surgery. The two groups were compared before and after treatment on scales such as the AOFAS ankle hindfoot score. Meanwhile, the patients' BMD and levels of inflammatory factors such as tumor cell necrosis factor-α (TNF-α) were compared before and after treatment. Results The Kofoed and AOFAS scale scores were higher for mild walking combined with arthroscopic surgery than for conventional treatment (P < 0.05), and their pain visual analogue VAS scores were lower than for conventional treatment (P < 0.05). In Group B, the postoperative BMD increase was significantly higher (P < 0.05). The R-value between PDGF bone growth factor and BMD was 0.957 and the R-value between VEGF growth factor and BMD was 0.903. The R-value between patient age and BMD was -0.936 and the R-value between patient BMI and BMD was -0.913. The treatment efficiency in Group B was 96.7 %. Conclusion The results prove that light walking combined with arthroscopic surgery is suitable for the surgical treatment of patients with ankle arthritis because it has a better therapeutic effect and makes patients' BMD level improved.