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INTRODUCTION: Quantitative gait analysis (QGA) has the potential to support clinician decision-making. However, it is not yet widely accepted in practice. Evidence for clinical efficacy (i.e., efficacy and effectiveness), as well as a users' perspective on using the technology in clinical practice (e.g., ease of use and usefulness) can help impact their widespread adoption. OBJECTIVE: To synthesize the literature on the clinical efficacy and clinician perspectives on the use of gait analysis technologies in the clinical care of adult populations. METHODS: This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included peer-reviewed and gray literature (i.e., conference abstracts). A search was conducted in MEDLINE (Ovid), CENTRAL (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and SPORTDiscus (EBSCO). Included full-text studies were critically appraised using the JBI critical appraisal tools. RESULTS: A total of 15 full-text studies and two conference abstracts were included in this review. Results suggest that QGA technologies can influence decision-making with some evidence to suggest their role in improving patient outcomes. The main barrier to ease of use was a clinician's lack of data expertise, and main facilitator was receiving support from staff. Barriers to usefulness included challenges finding suitable reference data and data accuracy, while facilitators were enhancing patient care and supporting clinical decision-making. SIGNIFICANCE: This review is the first step to understanding how QGA technologies can optimize clinical practice. Many gaps in the literature exist and reveal opportunities to improve the clinical adoption of gait analysis technologies. Further research is needed in two main areas: 1) examining the clinical efficacy of gait analysis technologies and 2) gathering clinician perspectives using a theoretical model like the Technology Acceptance Model to guide study design. Results will inform research aimed at evaluating, developing, or implementing these technologies. FUNDING: This work was supported by the Walter and Maria Schroeder Institute for Brain Innovation and Recovery and AGE-WELL Graduate Student Award in Technology and Aging [2021,2022].
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Análisis de la Marcha , Estudiantes , Adulto , Humanos , Encéfalo , Resultado del TratamientoRESUMEN
Background: Sports are physical activities that provide physical, psychological, and social benefits for individuals with spinal cord injury/disease (SCI/D). However, most sports research has been completed on individuals with SCI/D who are aged >50 years, even though the majority of people with SCI/D are aged >50 years. Despite substantial evidence supporting sports for older adults not living with a disability, there is currently no research examining the impact of sports for adults with SCI/D aged ≥50 years. Objectives: To explore the perceptions and experiences of individuals with SCI/D aged 50 years or older who participate in sports in the community. Methods: Fifteen adults with SCI/D aged ≥50 years who participated in community-based sports were interviewed. Interviews were audio-recorded and transcribed verbatim. Conventional content analysis was applied to the data. Results: The overarching theme identified was that sports are fun and adaptable physical activities that have the potential to optimize physical, psychological, and social health in all people with SCI/D, regardless of age. Within this overarching theme, six categories surfaced: (1) importance of participating in sports later in life, (2) prioritizing health over performance, (3) uncertainties about participating in sports later in life, (4) reflections on participating in sports later in life, (5) beliefs on alternative sports involvement, and (6) advice for other aging adults with SCI/D considering sports. Conclusion: Sports are perceived to provide physical, psychological, and social benefits for individuals with SCI/D aged 50 years or older. Findings will inform the development of future adaptive sports programs for older individuals with SCI/D.
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Personas con Discapacidad , Traumatismos de la Médula Espinal , Humanos , Anciano , Traumatismos de la Médula Espinal/psicología , Calidad de Vida , Examen FísicoRESUMEN
Background: Difficulty controlling balance is one of the major contributors to the increased risk of falls among individuals with stroke. It is important to use reliable and objective measures to improve examination of balance impairments post-stroke, and to in turn inform clinical decision-making. The main objective of this study was to examine the relative and absolute reliabilities of force plate-based balance measures in quiet standing, in the sub-acute stage of stroke recovery. Methods: Twenty-four people with sub-acute stroke (mean age = 61 years) performed two trials of quiet standing, each 30 s long. Sixteen force plate-based balance measures in the time, frequency, or nonlinear domains were calculated. Within-session test-retest reliabilities were investigated using intraclass correlation coefficient (ICC), standard error of measurement, and minimal detectable change. Results: Mean speed of displacements of the centre of pressure along the anterior-posterior axis (ICC = 0.91; CI95 % = [0.83, 0.95]), and directional weight-bearing asymmetry (ICC = 0.91; CI95 % = [0.82, 0.95]) demonstrated high relative reliabilities, followed by the speed-based symmetry index and absolute weight-bearing asymmetry (both ICCs = 0.86; CI95 % = [0.74, 0.93]). Conclusions: Mean speeds of centre of pressure, directional weight-bearing asymmetry, and speed-based symmetry index are the most reliable force plate-based measures that were evaluated in our study, and can be included in the balance assessments of individuals within the sub-acute stage of post-stroke recovery. These findings can better inform clinicians about the specific balance problems experienced by people in this population.
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BACKGROUND: Quantitative gait analysis can support clinical decision-making. These analyses can be performed using wearable sensors, nonwearable sensors, or a combination of both. However, to date, they have not been widely adopted in clinical practice. Technology adoption literature has highlighted the clinical efficacy of technology and the users' perspective on the technology (eg, ease of use and usefulness) as some factors that influence their widespread adoption. OBJECTIVE: To assist with the clinical adoption of quantitative gait technologies, this scoping review will synthesize the literature on their clinical efficacy and clinician perspectives on their use in the clinical care of adult patient populations. METHODS: This scoping review protocol follows the Joanna Briggs Institute methodology for scoping reviews. The review will include both peer-reviewed and gray literature (ie, conference abstracts) regarding the clinical efficacy of quantitative gait technologies and clinician perspectives on their use in the clinical care of adult patient populations. A comprehensive search strategy was created in MEDLINE (Ovid), which was then translated to 4 other databases: CENTRAL (Ovid), Embase (Ovid), CINAHL (EBSCO), and SPORTDiscus (EBSCO). The title and abstract screening, full-text review, and data extraction of relevant articles will be performed independently by 2 reviewers, with a third reviewer involved to support the resolution of conflicts. Data will be analyzed using content analysis and summarized in tabular and diagram formats. RESULTS: A search of relevant articles will be conducted in all 5 databases, and through hand-searching in Google Scholar and PEDro, including articles published up until December 2022. The research team plans to submit the final scoping review for publication in a peer-reviewed journal in 2023. CONCLUSIONS: The findings of this review will be presented at clinical science conferences and published in a peer-reviewed journal. This review will inform future studies designed to develop, evaluate, or implement quantitative gait analysis technologies in clinical practice. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39767.
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BACKGROUND: Gait asymmetry, which is common after stroke, is typically characterized using spatiotemporal parameters of gait that do not consider the aspect of movement coordination. In this manuscript, we examined whether an avatar-based feedback provided as a single-session intervention to improve gait symmetry also improved inter-limb coordination among people with stroke and we examined the relationship between changes in coordination and step length symmetry. METHODS: Twelve stroke participants walked on a self-paced treadmill with and without a self-avatar that replicated their locomotor movements in real time. Continuous relative phase and angular coefficient of correspondence calculated using bilateral sagittal hip movements were used to quantify temporal and spatial interlimb coordination, respectively. Spatial gait symmetry, previously shown to improve with the avatar feedback, was quantified using step length ratio between both limbs, with the largest value as numerator. FINDINGS: Participants who improved their spatial symmetry during avatar exposure also improved their temporal coordination, while spatial coordination remained unchanged. Overall, improvements in spatial symmetry correlated positively with improvements in temporal coordination. The non-paretic hip and paretic ankle angle excursion in the sagittal plane also significantly increased during avatar exposure. INTERPRETATION: Improvements in gait symmetry may be explained by changes in interlimb coordination. Current data and existing literature further suggest that such improvements are largely driven by adaptations in non-paretic leg movements, notably at the hip. By providing real-time information on walking movements not affordable in other ways, avatar-based feedback shows great potential to improve gait symmetry and interlimb coordination post-stroke.
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Retroalimentación Sensorial , Caminata , HumanosRESUMEN
Dance interventions hold promise for improving gait and balance in people with neurological conditions. It is possible that synchronization of movement to the music is one of the mechanisms through which dance bestows physical benefits. This technical note will describe a novel method using a deep learning-based 2D pose estimator: OpenPose, alongside beat analysis of music to quantify movement-music synchrony during salsa dancing. This method has four components: i) camera setup and recording, ii) tempo/downbeat analysis and waveform cleanup, iii) OpenPose estimation and data extraction, and iv) synchronization analysis. Four participants performed a solo basic salsa step continuously for 90 s to a salsa track while their movements and the music were recorded with a webcam. Two conditions were recorded for each participant: one in which they danced on the beat of the music and one where they did not. This data was then extracted from OpenPose and analyzed. Median asynchrony values highlighted differences between participants with and without dance training and between on- and off-beat conditions, indicating that this method may be an effective means to quantify a dancer's asynchrony while performing a basic salsa step.
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Baile , Aprendizaje Profundo , Música , Humanos , MovimientoRESUMEN
ABSRACT. Human gait is inherently rhythmical, thus walking to rhythmic auditory stimulation is a promising intervention to improve temporal gait asymmetry (TGA) following neurologic injury such as stroke. However, the degree of benefit may relate to an individual's underlying rhythmic ability. We conducted an initial investigation into the relationship between rhythm abilities and responsiveness of TGA when walking to a metronome. TGA was induced in neurotypical young adults with ankle and thigh cuff weights. Participants were grouped by strong or weak rhythm ability based on beat perception and production tests. TGA was induced using a unilateral load affixed to the non-dominant leg. Participants walked under three conditions: uncued baseline, metronome set to 100% of baseline cadence, and metronome set to 90% of baseline cadence. Repeated measures analysis using generalized estimating equations was conducted to determine how rhythm ability affected TGA response in each walking condition. Most participants improved TGA when walking to a metronome at either tempo compared to baseline; however, this improvement did not differ between strong and weak rhythm ability groups. Those who scored worse on the rhythm perception test also were poorer at synchronizing their steps to the beat. The induced TGA is smaller than what is commonly experienced after stroke. A larger induced TGA may be necessary to reveal subtle differences in responsiveness to rhythmical auditory stimulation between those with strong and weak rhythm abilities.
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Trastornos Neurológicos de la Marcha , Accidente Cerebrovascular , Estimulación Acústica , Señales (Psicología) , Marcha/fisiología , Humanos , Caminata , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Temporal gait asymmetry (TGA) affects 55% of people with stroke. This study investigated the effects of augmented feedback during overground gait training, on TGA. METHODS: Eighteen people with chronic stroke were randomized to receive one of two feedback displays (A or B) and one of three feedback frequencies; no feedback (0%), after alternate walking trials (50%) or after every trial (100%). Display A depicted the TGA ratio as a vertical line along a horizontal axis with perfect symmetry in the middle. Display B depicted single limb stance duration of each leg as a bar graph. Participants completed 25 repetitions of 30 second trials with their assigned feedback (acquisition). Participants completed 10 repetitions of 30 second trials without feedback 24 hours later (retention). A pressure sensitive mat recorded TGA and speed. Changes in TGA and speed were investigated by plotting individual motor learning curves and fitting a curve with locally estimated scatterplot smoothing (LOESS) for each feedback group. An effect of feedback was defined a priori as a LOESS fitted curve with a decreasing slope from acquisition to retention. RESULTS: LOESS curve exhibited a decreasing slope for TGA in the 100B group only and for speed in the 50A and 0FB groups. DISCUSSION: This study provides preliminary evidence that visual feedback delivered at a high frequency during a single session of overground walking can change TGA post-stroke without reducing gait speed. An overground gait intervention with high frequency visual feedback to improve TGA post-stroke is worthwhile to investigate.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Retroalimentación , Marcha , Humanos , Accidente Cerebrovascular/complicaciones , CaminataRESUMEN
Purpose: Physiotherapists use observational movement analysis (OMA) to inform clinical reasoning. This study aimed to (1) determine the feasibility of characterizing eye gaze behaviour during OMA with eye-tracking technology, (2) characterize experienced neurological physiotherapists' and physiotherapy students' eye gaze behaviour during OMA, and (3) investigate differences in eye gaze behaviour during OMA between physiotherapy students and experienced physiotherapists. Method: Eight students and eight physiotherapists wore an eye-tracking device while watching a video of a person with a history of stroke and subsequent concussion perform sit to stand. Feasibility criteria were (1) successful calibration of the eye tracker, and successful collection of data, for 80% of the participants and (2) moderate interrater reliability of the investigators, measured by intra-class correlation coefficients (ICCs). Three investigators independently recorded the participants' foveal fixations. Differences between physiotherapists and students in number of fixations, duration per fixation, and total duration of fixations were evaluated using unpaired t-tests, mean differences, and 95% CIs. Results: Data were collected for all participants. ICCs ranged from 0.64 to 0.78. Fixations by physiotherapists were shorter (mean 368.5 [SD 80.8] ms) and greater in number (mean 18.9 [SD 2.2]) than those by students (mean 459.0 [SD 64.2] ms, p = 0.03, and mean 15.9 [SD 2.7], p = 0.03), respectively. Conclusions: Measuring eye gaze behaviour during OMA using eye tracker technology is feasible. Physiotherapists made more fixations of shorter duration than students. Further investigation of how experienced therapists perform OMA and apply it to clinical reasoning may inform the instruction of OMA.
Objectif : les physiothérapeutes font appel à l'analyse observationnelle des mouvements (AOM) pour éclairer leur raisonnement clinique. La présente étude visait à 1) déterminer la faisabilité de caractériser le comportement du regard pendant l'AOM par la technologie de l'oculométrie, 2) caractériser le comportement du regard des physiothérapeutes neurologiques expérimentés et des étudiants en physiothérapie pendant l'AOM et 3) examiner les différences de comportement du regard des élèves physiothérapeutes par rapport aux physiothérapeutes d'expérience pendant l'AOM. Méthodologie : huit étudiants et huit physiothérapeutes ont porté un oculomètre en regardant la vidéo d'une personne ayant des antécédents d'accident vasculaire cérébral (AVC) et de commotion subséquente pour effectuer l'exercice assis-debout. Les critères de faisabilité s'établissaient comme suit : 1) la calibration réussie de l'oculomètre et la collecte réussie des données pour 80 % des participants et 2) une variabilité interévaluateurs modérée des chercheurs, mesurée par les coefficients de corrélation intraclasse (CCI). Trois chercheurs ont enregistré la fixation fovéale des participants. Ils ont évalué les différences entre les physiothérapeutes et les étudiants pour ce qui est du nombre de fixations, de la durée de chaque fixation et de la durée totale des fixations à l'aide des tests de Student non appariés, des différences moyennes et des intervalles de confiance à 95 %. Résultats : les données ont été colligées pour tous les participants. Les CCI se situaient entre 0,64 et 0,78. Les fixations des physiothérapeutes étaient plus courtes (368,5 [ÉT 80,8] ms) et plus fréquentes (18,9 [ÉT 2,2]) que celles des étudiants (459,0 [ÉT 64,2] ms, p = 0,03; 15,9 [ÉT 2,7], p = 0,03), respectivement. Conclusion : il est possible de mesurer le comportement du regard par oculométrie pendant l'AOM. Les physiothérapeutes avaient plus de fixations de courte durée que les étudiants. D'autres recherches sur la manière dont les thérapeutes d'expérience procèdent à l'AOM et l'appliquent à leur raisonnement clinique pourront éclairer les directives sur l'AOM.
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OBJECTIVES: To (1) characterize study paradigms used to investigate motor learning (ML) poststroke and (2) summarize the effects of different ML principles in promoting skill acquisition and retention. Our secondary objective is to evaluate the clinical utility of ML principles on stroke rehabilitation. DATA SOURCES: Medline, Excerpta Medica Database, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception on October 24, 2018 and repeated on June 23, 2020. Scopus was searched on January 24, 2019 and July 22, 2020 to identify additional studies. STUDY SELECTION: Our search included keywords and concepts to represent stroke and "motor learning. An iterative process was used to generate study selection criteria. Three authors independently completed title, abstract, and full-text screening. DATA EXTRACTION: Three reviewers independently completed data extraction. DATA SYNTHESIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews were used to guide our synthesis. Thirty-nine studies were included. Study designs were heterogeneous, including variability in tasks practiced, acquisition parameters, and retention intervals. ML principles investigated included practice complexity, feedback, motor imagery, mental practice, action observation, implicit and explicit information, aerobic exercise, and neurostimulation. An additional 2 patient-related factors that influence ML were included: stroke characteristics and sleep. Practice complexity, feedback, and mental practice/action observation most consistently promoted ML, while provision of explicit information and more severe strokes were detrimental to ML. Other factors (ie, sleep, practice structure, aerobic exercise, neurostimulation) had a less clear influence on learning. CONCLUSIONS: Improved consistency of reporting in ML studies is needed to improve study comparability and facilitate meta-analyses to better understand the influence of ML principles on learning poststroke. Knowledge of ML principles and patient-related factors that influence ML, with clinical judgment can guide neurologic rehabilitation delivery to improve patient motor outcomes.
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Nearly 60% of individuals with stroke walk with temporal gait asymmetry (TGA; a phase inequality between the legs during gait). About half of individuals with TGA are unable to correctly identify the presence or direction of their asymmetry. If patients are unable to perceive their gait errors, it will be harder to correct them to improve their gait pattern. Perception of gait pattern error may be affected by the stroke itself; therefore, the objectives of this study were to determine how the gait of neurotypical individuals changes with an induced temporal asymmetry, and how perception of that TGA compares to actual asymmetry both before and after 15-min of exposure to the induced asymmetry. After baseline symmetry (measured as symmetry index (SI)) was assessed with a pressure sensitive mat, participants (n = 29) walked for 15 min over-ground with cuff weights (7.5% of body weight) on their non-dominant leg to induce TGA. Presence, direction, and magnitude of TGA was measured at five time points: 1) baseline, 2) immediately after unilateral loading (early adaptation (EA)), 3) at the end of 15 min of walking (late adaptation (LA)), 4) immediately after load removal (early deadaptation (EDA)), and 5) after the participant indicated that their gait had returned to baseline symmetry (late deadaptation (LDA). Presence, direction, and magnitude of perceived TGA was measured by self-report. Measured and perceived TGA changes over time were assessed with separate one-way repeated measures analyses of variance. Agreement between measured and perceived TGA was assessed. During EA, all participants walked asymmetrically, spending more time on the non-loaded limb compared to baseline (-12.67 [95%CI -14.56, -10.78], p < 0.0001). All but one participant perceived this TGA, however only fifteen (52%) correctly perceived both TGA presence and direction. At LA, the group remained asymmetric (-9.22 [95%CI -11.32, -7.12], p < 0.0001), but only 9 participants (31%) correctly perceived both the presence and direction of their TGA. Visual inspection of the data at each time point revealed most participants perceived TGA magnitude as greater than actual TGA. Overall, we find that TGA can be induced and maintained in neurotypical young adults. Perception of TGA direction is inaccurate and perception of TGA magnitude is grossly overestimated. Perceptions of TGA do not improve after a period of exposure to the new walking pattern. These preliminary findings indicate that accurately perceiving an altered gait pattern is a difficult task even for healthy young adults.
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Trastornos Neurológicos de la Marcha , Marcha , Adaptación Fisiológica , Humanos , Percepción , Caminata , Adulto JovenRESUMEN
BACKGROUND: The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders. OBJECTIVE: To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals. METHODS: Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session. RESULTS: Thirty participants completed the protocol, ten per arm [14 women; mean ageâ=â55.9; mean time post-strokeâ=â66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained. CONCLUSIONS: The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.
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Cognición/fisiología , Imágenes en Psicoterapia/métodos , Musicoterapia/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Adulto , Anciano , Señales (Psicología) , Función Ejecutiva/fisiología , Femenino , Humanos , Imágenes en Psicoterapia/tendencias , Masculino , Persona de Mediana Edad , Música/psicología , Musicoterapia/tendencias , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/psicología , Prueba de Secuencia Alfanumérica , Resultado del TratamientoRESUMEN
BACKGROUND: Traumatic brain injury has multiple impacts on gait including decreased speed and increased gait variability. Rhythmic auditory stimulation (RAS) gait training uses the rhythm and timing structure of music to train and ultimately improve slow and variable walking patterns. OBJECTIVE: To describe the feasibility of RAS gait training in community-dwelling adults with traumatic brain injury (TBI). A secondary objective is to report changes in spatiotemporal gait parameters and clinical measures of balance and walking endurance. METHODS: Two individuals with a TBI participated in nine sessions of gait training with RAS over a 3-week period. At baseline, post-training and 3-week follow-up, spatiotemporal parameters of walking were analyzed at preferred pace, maximum pace and dual-task walking conditions. Secondary outcomes included the Community Balance and Mobility Scale and the 6-Minute Walk Test. Feasibility was assessed using reports of physical fatigue, adverse event reporting, and perceived satisfaction. RESULTS: Both participants completed all 9 planned intervention sessions. The sessions were well tolerated with no adverse events. Participant 1 and 2 exhibited different responses to the intervention in line with the therapeutic goals set with the therapist. Participant 1 exhibited improved speed and decreased gait variability. Participant 2 exhibited reduced gait speed but less fatigue during the 6MWT. CONCLUSIONS: RAS was found to be a safe and feasible gait intervention with the potential to improve some aspects of gait impairments related to gait speed, gait variability, dynamic balance and walking endurance. Further investigation including a pilot randomized controlled trial is warranted.
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Estimulación Acústica/tendencias , Lesiones Traumáticas del Encéfalo/terapia , Terapia por Ejercicio/tendencias , Marcha/fisiología , Vida Independiente/tendencias , Estimulación Acústica/psicología , Adulto , Lesiones Traumáticas del Encéfalo/psicología , Terapia por Ejercicio/psicología , Estudios de Factibilidad , Humanos , Vida Independiente/psicología , Masculino , Persona de Mediana Edad , Velocidad al Caminar/fisiologíaRESUMEN
OBJECTIVE: To quantify the effect of multiple sclerosis (MS) on spatiotemporal gait characteristics accounting for disability severity and fall classification. DATA SOURCES: MEDLINE (1946-August 2018), Allied and Complementary Medicine Database (1985-2018 August), and PsycINFO (1806-August 2018) were searched for terms on MS and gait. STUDY SELECTION: Dual independent screening was conducted to identify observational, cross-sectional studies that compared adults with MS grouped according to Expanded Disability Status Scale (EDSS) level or fall history, reported on spatiotemporal gait characteristics, and were published in English. The search retrieved 5891 results, of which 12 studies satisfied the inclusion criteria. DATA EXTRACTION: Two authors worked independently to extract and verify data on publication details, study methodology, participant characteristics, gait outcomes, conclusions, and limitations. Risk of bias was assessed using the QualSyst critical appraisal tool. A random-effects meta-regression and meta-analysis were conducted on pooled data. DATA SYNTHESIS: All studies received quality ratings of very good to excellent and collectively examined 1513 individuals with MS. With every 1-point increase in EDSS, significant changes (P<.05) were observed in gait speed (-0.12 m/s; 95% confidence interval (CI), 0.08-0.15), step length (-0.04 m; 95% CI, 0.03-0.05), step time (+0.04 seconds; 95% CI, 0.02-0.06), step time variability (+0.009 seconds; 95% CI, 0.003-0.016), stride time (+0.08 seconds; 95% CI, 0.03-0.12), cadence (-4.4 steps per minute; 95% CI, 2.3-6.4), stance phase duration (+0.8% gait cycle; 95% CI, 0.1-1.5), and double support time (+3.5% gait cycle; 95% CI, 1.5-5.4). Recent fallers exhibited an 18% (95% CI, 13%-23%) reduction in gait speed compared with nonfallers (P<.001). CONCLUSIONS: This review provides the most accurate reference values to-date that can be used to assess the effectiveness of MS gait training programs and therapeutic techniques for individuals who differ on disability severity and fall classification. Some gait adaptations could be part of adopting a more cautious gait strategy and should be factored into the design of future interventions.
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Accidentes por Caídas , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/rehabilitación , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/rehabilitación , Evaluación de la Discapacidad , HumanosRESUMEN
OBJECTIVE: To investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis. DESIGN: Randomized-controlled pilot study. SETTING: University research facility. PARTICIPANTS: Community-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months). INTERVENTION: Two baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment. MAIN OUTCOME MEASURES: Fugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)-amount of use scale and trunk impairment scale. RESULTS: All groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63). CONCLUSION: TIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.
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Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely. Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI. Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI. Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months. Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a "neural internetwork" model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.
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PURPOSE: Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke. METHODS: A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (n = 9), rehabilitation therapists (n = 6), and dance instructors (n = 8). Focus groups were audio-recorded and transcribed verbatim, providing the raw data. Analysis of the focus group transcripts were completed using the DEPICT model of collaborative qualitative analysis. RESULTS: This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes. CONCLUSION: Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke.IMPLICATIONS FOR REHABILITATIONDance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community.A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class.Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves.The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1-2 h.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Adaptación Fisiológica , Grupos Focales , Humanos , Investigación CualitativaRESUMEN
Rapid motor learning may occur in situations where individuals perceive a threat if they do not perform a task well. This rapid motor learning may be facilitated by improved motor performance and, consequently, more errorless practice. As a first step towards understanding the role of perceived threat on rapid motor learning, the purpose of this study was to determine how performance of a motor task is affected in situations where perceived threat is high. We hypothesized that perceived threat in a virtual environment would result in improved performance of a walking task (i.e., walking on a narrow beam). Results demonstrated that increased perceived threat did not yield statistically significantly greater balance performance in the high-threat virtual environment (median percentage of successful steps: 78.8%, 48.3%, and 55.2% in the real low-threat, virtual low-threat, and virtual high-threat environments, respectively). These results may be partially attributed to habituation to threat over time and practice. If implemented carefully, virtual reality technology can be an effective tool for investigating walking balance in environments that are perceived as threatening.
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Equilibrio Postural/fisiología , Postura , Realidad Virtual , Caminata/fisiología , Ansiedad/psicología , Femenino , Habituación Psicofisiológica , Humanos , Aprendizaje , Masculino , Adulto JovenRESUMEN
Temporal gait asymmetry (TGA) is a persistent post-stroke gait deficit. Compared to conventional gait training techniques, rhythmic auditory stimulation (RAS; i.e., walking to a metronome) has demonstrated positive effects on post-stroke TGA. Responsiveness of TGA to RAS may be related to several factors including motor impairment, time post-stroke, and individual rhythm abilities. The purpose of this study was to investigate the relationship between rhythm abilities and responsiveness of TGA when walking to RAS. Assessed using behavioral tests of beat perception and production, participants with post-stroke TGA (measured as single limb support time ratio) were categorized according to rhythm ability (as strong or weak beat perceivers/producers). We assessed change in TGA between walking without cues (baseline) and walking while synchronizing footsteps with metronome cues. Most individuals with stroke were able to maintain or improve TGA with a single session of RAS. Within-group analyses revealed a difference between strong and weak rhythm ability groups. Strong beat perceivers and producers showed significant reduction (improvement) in TGA with the metronome. Those with weak ability did not and exhibited high variability in the TGA response to metronome. Moreover, individuals who worsened in TGA when walking to metronome had poorer beat production scores than those who did not change in TGA. However, no interaction between TGA improvement when walking to metronome and rhythm perception or production ability was found. While responsiveness of TGA to RAS did not significantly differ based on strength of rhythm abilities, these preliminary findings highlight rhythm ability as a potential consideration when treating post-stroke individuals with rhythm-based treatments.