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1.
J Sports Sci ; 38(1): 62-69, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31623527

RESUMEN

This study investigated whether using an inertial measurement unit (IMU) can identify different walking conditions, including level walking (LW), descent (DC) and ascent (AC) slope walking as well as downstairs (DS) and upstairs (US) walking. Thirty healthy participants performed walking under five conditions. The IMU was stabilised on the exterior of the left shoe. The data from IMU were used to establish a customised prediction model by cut point and a prediction model by using deep learning method. The accuracy of both prediction models was evaluated. The customised prediction model combining the angular velocity of dorsi-plantar flexion in the heel-strike (HS) and toe-off (TO) phases can distinctly determine real conditions during DC and AC slope, DS, and LW (accuracy: 86.7-96.7%) except for US walking (accuracy: 60.0%). The prediction model established by deep learning using the data of three-axis acceleration and three-axis gyroscopes can also distinctly identify DS, US, and LW with 90.2-90.7% accuracy and 84.8% and 82.4% accuracy for DC and AC slope walking, respectively. In conclusion, inertial measurement units can be used to identify walking patterns under different conditions such as slopes and stairs with customised prediction model and deep learning prediction model.


Asunto(s)
Acelerometría/instrumentación , Aprendizaje Profundo , Subida de Escaleras/fisiología , Caminata/fisiología , Aceleración , Adulto , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Movimiento/fisiología , Análisis y Desempeño de Tareas , Dispositivos Electrónicos Vestibles , Adulto Joven
2.
Sports Biomech ; 19(1): 120-140, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31456487

RESUMEN

Dynamic stability of locomotion plays an important role in running injuries, particularly during trail running where ankle injuries occur frequently. Several studies have investigated dynamic stability of locomotion using wearable accelerometer measurements. However, no study has reviewed how dynamic stability of locomotion is quantified using accelerometry. Therefore, the present review aims to synthetise the methods and findings of studies investigating stability related parameters measured by accelerometry, during locomotion on various surfaces, and among asymptomatic participants. A systematic search of studies associated with locomotion was conducted. Only studies including assessment of dynamic stability parameters based on accelerometry, including at least one group of asymptomatic participants, and conditions that occur during trail running were considered relevant for this review. Consequently, all retrieved studies used a non-obstructive portable accelerometer or an inertial measurement unit. Fifteen studies used a single tri-axial accelerometer placed above the lumbar region allowing outdoor recordings. From trunk accelerations, a combination of index of cycle repeatability and signal dispersion can adequately be used to assess dynamic stability. However, as most studies included indoor conditions, studies addressing the biomechanics of trail running in outdoor conditions are warranted.


Asunto(s)
Acelerometría/métodos , Carrera/fisiología , Caminata/fisiología , Fenómenos Biomecánicos , Ambiente , Marcha/fisiología , Humanos , Factores de Riesgo , Carrera/lesiones , Caminata/lesiones
3.
Medicine (Baltimore) ; 98(50): e18286, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852105

RESUMEN

RATIONALE: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs). PATIENT CONCERNS: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. DIAGNOSIS: The patient was tetraplegia with incomplete SCI at C3-C4. INTERVENTIONS: The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes. OUTCOMES: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO2 tests. LESSIONS: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.


Asunto(s)
Vértebras Cervicales/lesiones , Terapia por Ejercicio/instrumentación , Dispositivo Exoesqueleto , Extremidad Inferior/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Velocidad al Caminar/fisiología , Caminata/fisiología , Diseño de Equipo , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/fisiopatología
4.
Clin Interv Aging ; 14: 1555-1565, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31695344

RESUMEN

Purpose: Nordic walking (NW) has been recommended as a form of exercise for clinical populations. Despite intervention programs designed to face a clinical status may last several months, no longitudinal studies have compared the effect of NW to another usual form of exercise, like walking (W). We evaluated the effects of diet combined with a long-supervised NW versus W training on body composition, aerobic capacity and strength in overweight adults. Patients and methods: Thirty-eight participants, randomized into a NW (n=19, 66±7 years, body mass index (BMI) 33±5)) and a W (n=19, 66±8 years, BMI 32±5) group, followed a diet and a supervised training routine 3 times/week for 6 months. The variables assessed at baseline, after 3 and 6 months were: anthropometric indexes (ie, BMI and waist circumference (WC)), body composition, aerobic capacity (oxygen consumption (VO2peak), peak power output (PPO), 6-min walking test (6MWT)) and strength (maximal voluntary contraction of biceps brachialis (MVCBB) and quadriceps femoris (MVCQF), chair stand and arm curl (AC)). Results: After 6 months both NW and W group decreased significantly BMI (6% and 4%, respectively) and WC (8% and 4%, respectively), but only the NW group reduced (P<0.05) total body fat (8%), android fat (14%) and leg fat (9%). After 6 months, PPO increased (P<0.05) in both groups, but VO2peak improved (P<0.05) only in the NW group (8%). After 6 months, 6MWT increased (P<0.001) in both groups and only the NW group improved (P<0.05) in MVCBB (14%), MVCQF (17%) and AC (35%). Conclusion: Our results suggest that NW can give in some relevant health parameters, greater and faster benefits than W. Thus, NW can be a primary tool to counteract the obesity and overweight state in middle-aged adults.


Asunto(s)
Dieta , Terapia por Ejercicio/métodos , Sobrepeso/terapia , Caminata/fisiología , Adiposidad , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Consumo de Oxígeno , Músculo Cuádriceps/fisiología , Circunferencia de la Cintura , Prueba de Paso
5.
Medicine (Baltimore) ; 98(45): e17874, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702655

RESUMEN

BACKGROUND: Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD). METHODS: Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition). RESULTS: In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023). CONCLUSIONS: Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.


Asunto(s)
Estimulación Acústica/métodos , Señales (Psicología) , Trastornos Neurológicos de la Marcha/terapia , Estimulación Magnética Transcraneal/métodos , Anciano , Estudios Cruzados , Potenciales Evocados Auditivos/fisiología , Trastornos Neurológicos de la Marcha/etiología , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Rendimiento Físico Funcional , Modalidades de Fisioterapia , Caminata/fisiología
6.
Clin Ter ; 170(5): e357-e363, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31612193

RESUMEN

AIM OF THE STUDY: Cilostazol is a phosphodiesterase III inhibitor that has anti-inflammatory and immunomodulatory effects and can act with beneficial effect in Dry Eye Syndrome (DES). This clinical trial evaluates the effects of cilostazol on the tear film. MATERIALS AND METHODS: Following the run-in period, subjects were randomly into two groups: 40 subjects treated with cilostazol and 40 no-treated subjects. The Walking Impairment Questionnaire (WIQ) has been administered to all patients. RESULT: The data obtained from comparison of the two study groups A and B were, respectively, the following: Schirmer I: 10.2±0.2 Vs 13.8±0.4 (p< 0.001); Schirmer II: 3.8±0.1 Vs 4.6±0.2 (p<0.001); Break-up time (BUT) 4.2±0.3 Vs 6.5±0.2 (p<0.001) with disappearing of symptoms. The WIQ showed a significant difference in the walking distance (p<0.05) and calf pain severity (p<0.005) of treated patients. In comparison with the placebo group, treated patients showed an improvement (p<0.03) in calf pain severity. CONCLUSION: The administration of cilostazol was effective, in reducing DES and improve walking distance questionnaire.


Asunto(s)
Cilostazol/uso terapéutico , Síndromes de Ojo Seco/tratamiento farmacológico , Claudicación Intermitente/tratamiento farmacológico , Enfermedad Arterial Periférica/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Caminata/fisiología , Anciano , Síndromes de Ojo Seco/etiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Encuestas y Cuestionarios , Resultado del Tratamiento
7.
Int J Behav Nutr Phys Act ; 16(1): 86, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615522

RESUMEN

BACKGROUND: Living in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers. METHODS: The Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999-2000, 2004-05, and 2011-12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants' homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation. RESULTS: There was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P < 0.001), and high-density lipoprotein cholesterol (P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590). CONCLUSIONS: Our mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Planificación Ambiental , Enfermedades Metabólicas/prevención & control , Características de la Residencia , Caminata/fisiología , Adulto , Anciano , Australia , Presión Sanguínea , Peso Corporal , Diabetes Mellitus Tipo 2/prevención & control , Ejercicio/fisiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad/prevención & control , Autoinforme , Circunferencia de la Cintura
8.
J Frailty Aging ; 8(4): 205-209, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637407

RESUMEN

BACKGROUND: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. OBJECTIVES: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. DESIGN: This was a clinical demonstration project/quality improvement project. SETTING: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). PARTICIPANTS: Older Veterans, aged ≥60 years. INTERVENTION: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. MEASUREMENTS: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. RESULTS: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). CONCLUSIONS: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.


Asunto(s)
Terapia por Ejercicio/métodos , Fragilidad/prevención & control , Veteranos/estadística & datos numéricos , Caminata/fisiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Velocidad al Caminar/fisiología
9.
Gait Posture ; 74: 250-254, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31590046

RESUMEN

INTRODUCTION: Simulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether subjects with reduced hip ROM (Stiff hip) or hip flexor weakness (Weak hip) exhibit ankle compensations during walking and investigate redistribution of power in the lower extremity joints. METHODS: Retrospective gait data were reviewed (IRB-approved hip registry). Preoperative kinematic/kinetic walking data were collected in patients with: adolescent hip dysplasia (AHD), femoral acetabular impingement (FAI), and Legg-Calvé Perthes disease (Perthes). AHD patients with significantly weak hip flexors on their affected side were included (Weak hip group). The Gait Profile Score (GPS) was calculated on the affected side of the FAI and Perthes groups to identify patients who had a Stiff hip. Patients who had undergone a hip arthrodesis (Fusion) were also included (Stiff hip group). Ankle kinematics/kinetics were compared to healthy participants (Control). The total positive work of sagittal plane hip, knee and ankle power were compared along with the distribution of power. RESULTS: Patients in the Weak/Stiff hip groups did not walk with greater ankle plantarflexion, peak push-off power or positive ankle work on their affected sides compared to Control. Ankle work contribution (percentage of total positive work) on the affected or unaffected sides was greater in the Perthes and Hip Fusion patients compared to Control. Significant gait abnormalities on the unaffected side were observed. CONCLUSIONS: Patients with a weak or stiff hip did exhibit altered ankle mechanics during walking. Greater percent ankle work contribution appeared to correspond with hip stiffness. In patients with hip pathology the redistribution of power among the lower extremity joints can highlight the importance of preserving ankle function.


Asunto(s)
Articulación del Tobillo/fisiología , Pinzamiento Femoroacetabular/fisiopatología , Marcha/fisiología , Adolescente , Adulto , Fenómenos Biomecánicos , Estudios de Casos y Controles , Femenino , Humanos , Extremidad Inferior/fisiopatología , Masculino , Rango del Movimiento Articular , Estudios Retrospectivos , Caminata/fisiología , Adulto Joven
10.
Int J Sports Med ; 40(13): 871-875, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31590189

RESUMEN

High amounts of sitting increase the risk of non-communicable disease and mortality. Treadmill desks make it possible to reduce sitting during the desk-based worker's day. This study investigated the acute effect on postural stability of interrupting prolonged sitting with an accumulated 2-h of light-intensity treadmill desk walking. Twenty-one sedentary adults participated in this randomized acute crossover trial, with two 6.5 h conditions: 1) uninterrupted sitting and 2) interrupted sitting with accumulated 2 h light-intensity treadmill desk walking. Pre- and post-condition, participants performed four postural stability tests on a pressure plate (bipedal and unipedal standing stance, eyes open and eyes closed). Anteroposterior center of pressure amplitude showed a significant condition x time interaction in bipedal eyes closed (F(1,20)=4.62, p=0.046) and unipedal eyes open (F(1,20)=9.42, p=0.006) tests, and mediolateral center of pressure amplitude in bipedal eyes closed (F(1,20)=6.12, p=0.023) and bipedal eyes open (F(1,12)=5.55, p=0.029) tests. In the significant interactions, amplitude increased pre to post condition in the uninterrupted sitting condition. The accumulated 2 h light-intensity treadmill desk walking ameliorated the negative effect of 6.5 h prolonged sitting on postural sway, supporting workplace treadmill desk use.


Asunto(s)
Ergometría/instrumentación , Balance Postural/fisiología , Sedestación , Caminata/fisiología , Lugar de Trabajo , Adulto , Estudios Cruzados , Femenino , Humanos , Diseño Interior y Mobiliario , Masculino , Persona de Mediana Edad , Salud Laboral , Análisis y Desempeño de Tareas
11.
Int J Behav Nutr Phys Act ; 16(1): 84, 2019 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-31590666

RESUMEN

BACKGROUND: Policymakers need accurate data to develop efficient interventions to promote transport physical activity. Given the imprecise assessment of physical activity in trips, our aim was to illustrate novel advances in the measurement of walking in trips, including in trips incorporating non-walking modes. METHODS: We used data of 285 participants (RECORD MultiSensor Study, 2013-2015, Paris region) who carried GPS receivers and accelerometers over 7 days and underwent a phone-administered web mobility survey on the basis of algorithm-processed GPS data. With this mobility survey, we decomposed trips into unimodal trip stages with their start/end times, validated information on travel modes, and manually complemented and cleaned GPS tracks. This strategy enabled to quantify walking in trips with different modes with two alternative metrics: distance walked and accelerometry-derived number of steps taken. RESULTS: Compared with GPS-based mobility survey data, algorithm-only processed GPS data indicated that the median distance covered by participants per day was 25.3 km (rather than 23.4 km); correctly identified transport time vs. time at visited places in 72.7% of time; and correctly identified the transport mode in 67% of time (and only in 55% of time for public transport). The 285 participants provided data for 8983 trips (21,163 segments of observation). Participants spent a median of 7.0% of their total time in trips. The median distance walked per trip was 0.40 km for entirely walked trips and 0.85 km for public transport trips (the median number of accelerometer steps were 425 and 1352 in the corresponding trips). Overall, 33.8% of the total distance walked in trips and 37.3% of the accelerometer steps in trips were accumulated during public transport trips. Residents of the far suburbs cumulated a 1.7 times lower distance walked per day and a 1.6 times lower number of steps during trips per 8 h of wear time than residents of the Paris core city. CONCLUSIONS: Our approach complementing GPS and accelerometer tracking with a GPS-based mobility survey substantially improved transport mode detection. Our findings suggest that promoting public transport use should be one of the cornerstones of policies to promote physical activity.


Asunto(s)
Acelerometría/métodos , Sistemas de Información Geográfica , Salud Pública , Transportes , Caminata/fisiología , Humanos , Procesamiento de Señales Asistido por Computador , Transportes/métodos , Transportes/estadística & datos numéricos
12.
Ideggyogy Sz ; 72(9-10): 317-323, 2019 Sep 30.
Artículo en Húngaro | MEDLINE | ID: mdl-31625698

RESUMEN

Gait disturbance is a major symptom in patients with multiple sclerosis. The Expanded Disability Status Scale (EDSS) was first used in clinical trials of multiple sclerosis for the assessment of disability, however it has become more and more widely used in clinical practice as well. Nowadays its use is essential in application of the new diagnostic criteria, the new clinical form classification and in monitoring the efficacy of therapies. EDSS is based on a standardised neurological examination, but focuses on those symptoms that are frequent in multiple sclerosis. Based on the examination it assesses seven functional systems: visual, brainstem, pyramidal, cerebellar, sensory, bowel-bladder and cerebral functions. EDSS scores can be determined based on the scores given in the functional systems and on testing the walking distance. In newer versions the "Ambulation score" has been added. This chapter clarifies the scores based on the maximal walking distance and the need for a walking aid to walk this distance. The Neurostatus/EDSS training method improves the reproducibility of the standardised neurological examination that forms the basis of the EDSS scoring. Of the tests assessing walking, the Timed-25 Foot Walk Test and the self-administered 12-Item Multiple Sclerosis Walking Scale are suitable for routine evaluation of walking performance. An increase of more than 20% in the Timed-25 Foot Walk may be considered a significant change in gait.


Asunto(s)
Personas con Discapacidad , Marcha , Esclerosis Múltiple/diagnóstico , Caminata/fisiología , Evaluación de la Discapacidad , Marcha/fisiología , Humanos , Esclerosis Múltiple/complicaciones , Reproducibilidad de los Resultados
13.
Pediatr Phys Ther ; 31(4): 373-378, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31568387

RESUMEN

PURPOSE: To evaluate the effect of plantar flexor strengthening associated with conventional physical therapy treatment in participants with idiopathic toe walking. METHODS: Thirty participants, of both sexes diagnosed with idiopathic toe walking, aged 5 and 11 years, will be recruited and randomized into 2 groups: the control group, who will undergo gait training, triceps surae muscle stretching, anterior tibial muscle strengthening, and motor sensory training, and the intervention group, who will undergo the same training as the control group and, additionally, triceps surae muscle strengthening. The intervention will be performed twice a week for 8 weeks. The participants will undergo a 3-dimensional gait kinematic analysis, passive amplitude of dorsiflexion movement, isometric dynamometry of the anterior tibial and triceps surae muscles, motor coordination, quality of life, and perception of the parents regarding the equinus gait at baseline and at the end of treatment. Quality of life will be reevaluated during a 24-week follow-up.


Asunto(s)
Fenómenos Biomecánicos/fisiología , Terapia por Ejercicio/métodos , Trastornos Neurológicos de la Marcha/rehabilitación , Trastornos del Movimiento/rehabilitación , Ejercicios de Estiramiento Muscular , Músculo Esquelético/fisiología , Caminata/fisiología , Niño , Preescolar , Femenino , Humanos , Masculino
14.
Gait Posture ; 74: 200-204, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31557663

RESUMEN

BACKGROUND: Due to increased sedentary workstyles, active workstations have shown the ability to increase activity while only moderately affecting work ability. However, previous examinations have not examine fine motor mousing tasks on tripping descriptors. RESEARCH QUESTION: What affect do mousing tasks of varying target size have on tripping descriptors during walking workstation use? METHODS: Three-dimensional kinematic data were collected while participants used a walking workstation completing one baseline and three mousing conditions of varying target sizes. RESULTS: Target size main effects (p < 0.001) detected decreased stride length in all experimental conditions, which were supported by moderate effect sizes, and decreased stance width and time in double limb support (p < 0.001 for both comparisons). Stance width differences resulted in large effect sizes between baseline and all conditions, while only moderate effect sizes were observed between time in double limb support in baseline compared to all conditions. No changes in knee flexion range of motion were observed in response to target size (p = 0.278). SIGNIFICANCE: These results indicate that walking workstation users shorten their stride length and decrease their base of support while completing mousing tasks. The placement of the upper extremities on the workstation desk likely acted as the primary mechanism to increase stability. It is concluded that performing mousing tasks of varying target size using a walking workstation does not pose greater risk for adverse gait events.


Asunto(s)
Atención/fisiología , Marcha/fisiología , Caminata/fisiología , Lugar de Trabajo , Adulto , Fenómenos Biomecánicos/fisiología , Femenino , Humanos , Masculino , Rango del Movimiento Articular/fisiología , Análisis y Desempeño de Tareas , Adulto Joven
15.
J Appl Biomech ; 35(5): 320-326, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31541067

RESUMEN

The authors tested 4 young healthy subjects walking with a powered knee exoskeleton to determine if it could reduce the metabolic cost of locomotion. Subjects walked with a backpack loaded and unloaded, on a treadmill with inclinations of 0° and 15°, and outdoors with varied natural terrain. Participants walked at a self-selected speed (average 1.0 m/s) for all conditions, except incline treadmill walking (average 0.5 m/s). The authors hypothesized that the knee exoskeleton would reduce the metabolic cost of walking uphill and with a load compared with walking without the exoskeleton. The knee exoskeleton reduced metabolic cost by 4.2% in the 15° incline with the backpack load. All other conditions had an increase in metabolic cost when using the knee exoskeleton compared with not using the exoskeleton. There was more variation in metabolic cost over the outdoor walking course with the knee exoskeleton than without it. Our findings indicate that powered assistance at the knee is more likely to decrease the metabolic cost of walking in uphill conditions and during loaded walking rather than in level conditions without a backpack load. Differences in positive mechanical work demand at the knee for varying conditions may explain the differences in metabolic benefit from the exoskeleton.


Asunto(s)
Metabolismo Energético , Dispositivo Exoesqueleto , Rodilla , Músculo Esquelético/metabolismo , Caminata/fisiología , Adulto , Prueba de Esfuerzo , Humanos , Masculino , Consumo de Oxígeno , Soporte de Peso
16.
J Rehabil Med ; 51(10): 797-804, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31544216

RESUMEN

OBJECTIVES: To describe physiotherapeutic interventions used in the post-acute inpatient rehabilitation of chronic critically ill patients with intensive-care-unit-acquired muscle weakness, and to determine the influence of such interventions on patients' ability to walk. METHODS: Chronic critically ill patients with intensive-care-unit-acquired muscle weakness who were in post-acute and rehabilitation units were included in a cohort study. During post-acute rehabilitation, the patients' functional status at baseline, all daily physiotherapeutic interventions, and ability to walk were documented. RESULTS: A total of 150 patients were investigated. In patients who regained walking ability, the most frequent interventions in the first 2 weeks of post-acute rehabilitation were practicing walking, sit-to-stand training, and balance training while sitting (total time per week: 48.03 (standard deviation (SD) 41.10), 20.13 (SD 21.12), and 12.37 (SD 26.95) min, respectively). The most frequent interventions in those who did not regain walking ability were passive-assistive movements, sit-to-stand training, and balance training while sitting (total time per week: 15.29 (SD 22.93), 15.15 (SD 22.75), and 14.85 (SD 16.99) min, respectively). The time spent walking increased the chance of regaining walking ability (adjusted hazard ratio = 1.017 per min walking, p < 0.0001). CONCLUSION: These results suggest that physiotherapy interventions in the rehabilitation of chronic critically ill patients with intensive-care-unit-acquired muscle weakness may stimulate walking function.


Asunto(s)
Enfermedad Crítica/rehabilitación , Debilidad Muscular/terapia , Modalidades de Fisioterapia , Estudios de Cohortes , Humanos , Unidades de Cuidados Intensivos , Caminata/fisiología
17.
Gait Posture ; 74: 205-211, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31561118

RESUMEN

BACKGROUND: Gait adaptability in old age can be examined by responses to various perturbations. Fatigability due to mental or muscle exercises can perturb internal cognitive and muscle resources, necessitating adaptations in gait. RESEARCH QUESTION: What are the effects of age and mental and muscle fatigability on stride outcomes and gait variability? METHODS: Twelve older (66-75yrs) and twelve young (20-25 yrs) adults walked at 1.2 m/s before and after two fatigue conditions in two separate sessions. Fatigue conditions were induced by repetitive sit-to-stand task (RSTS) and by 30-min of mental tasks and randomized between days (about a week apart). We calculated the average and coefficient of variation of stride length, width, single support, swing time and cadence, and the detrended fluctuations analysis (DFA) based on 120 strides time intervals. We also calculated multi-scale sample entropy (MSE) and the maximal Lyapunov exponent (λmax) of mediolateral (ML) and anteroposterior (AP) of the Center of Pressure (CoP) trajectories. RESULTS: In both age groups, RSTS modestly affected stride length, single support time, cadence, and CV of stride length (p ≤ 0.05), while the mental task did not affect gait. After fatigability, λmax - ML increased (p ≤ 0.05), independent of fatigue condition. All observed effects were small (η²: 0.001 to 0.02). SIGNIFICANCE: Muscle and mental fatigability had minimal effects on gait in young and healthy older adults possibly because treadmill walking makes gait uniform. It is still possible that age-dependent muscle activation underlies the uniform gait on the treadmill. Age- and fatigability effects might be more overt during real life compared with treadmill walking, creating a more effective model for examining gait and age adaptability to fatigability perturbations.


Asunto(s)
Adaptación Fisiológica/fisiología , Envejecimiento/fisiología , Fatiga/fisiopatología , Marcha/fisiología , Caminata/fisiología , Anciano , Análisis de Varianza , Prueba de Esfuerzo , Femenino , Humanos , Masculino
18.
J Rehabil Med ; 51(10): 723-733, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31511902

RESUMEN

OBJECTIVES: To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular demands, secondary health complications and user-satisfaction. DATA SOURCES: PubMed, Cochrane, Web of Science, Scopus, EBSCOhost and Engineering Village. STUDY SELECTION: Trials in which robotic locomotor training was used for a minimum of 3 participants with spinal cord injury. DATA EXTRACTION: Independent extraction of data by 2 reviewers using a pre-established data abstraction table. Quality of evidence assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). DATA SYNTHESIS: Total of 27 non-controlled studies representing 308 participants. Most studies showed decreases in exertion ratings, pain and spasticity and reported positive well-being post-intervention. Seven studies were included in meta-analyses on walking performance, showing significant improvements post-intervention (p < 0.05), with pooled effects for the 6-min walking test and 10-metre walking test of-0.94 (95% confidence interval (95% CI) -1.53,-0.36) and -1.22 (95% CI -1.87,-0.57), respectively. The Timed Up and Go Test showed a positive pooled effect of 0.74 (95% CI 0.36, 1.11). Improvements in walking parameters were seen with an increase in session number; however, no significant cardiovascular changes were found over time. CONCLUSION: Robotic locomotor training shows promise as a tool for improving neurological rehabilitation; however, there is limited evidence regarding its training benefits. Further high-powered, randomized controlled trials, with homogenous samples, are required to investigate these effects.


Asunto(s)
Modalidades de Fisioterapia , Robótica/métodos , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Humanos
19.
BMJ ; 366: l5101, 2019 09 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533934

RESUMEN

OBJECTIVE: To determine the safety and efficacy of aerobic exercise on activities of daily living in the subacute phase after stroke. DESIGN: Multicentre, randomised controlled, endpoint blinded trial. SETTING: Seven inpatient rehabilitation sites in Germany (2013-17). PARTICIPANTS: 200 adults with subacute stroke (days 5-45 after stroke) with a median National Institutes of Health stroke scale (NIHSS, range 0-42 points, higher values indicating more severe strokes) score of 8 (interquartile range 5-12) were randomly assigned (1:1) to aerobic physical fitness training (n=105) or relaxation sessions (n=95, control group) in addition to standard care. INTERVENTION: Participants received either aerobic, bodyweight supported, treadmill based physical fitness training or relaxation sessions, each for 25 minutes, five times weekly for four weeks, in addition to standard rehabilitation therapy. Investigators and endpoint assessors were masked to treatment assignment. MAIN OUTCOME MEASURES: The primary outcomes were change in maximal walking speed (m/s) in the 10 m walking test and change in Barthel index scores (range 0-100 points, higher scores indicating less disability) three months after stroke compared with baseline. Safety outcomes were recurrent cardiovascular events, including stroke, hospital readmissions, and death within three months after stroke. Efficacy was tested with analysis of covariance for each primary outcome in the full analysis set. Multiple imputation was used to account for missing values. RESULTS: Compared with relaxation, aerobic physical fitness training did not result in a significantly higher mean change in maximal walking speed (adjusted treatment effect 0.1 m/s (95% confidence interval 0.0 to 0.2 m/s), P=0.23) or mean change in Barthel index score (0 (-5 to 5), P=0.99) at three months after stroke. A higher rate of serious adverse events was observed in the aerobic group compared with relaxation group (incidence rate ratio 1.81, 95% confidence interval 0.97 to 3.36). CONCLUSIONS: Among moderately to severely affected adults with subacute stroke, aerobic bodyweight supported, treadmill based physical fitness training was not superior to relaxation sessions for maximal walking speed and Barthel index score but did suggest higher rates of adverse events. These results do not appear to support the use of aerobic bodyweight supported fitness training in people with subacute stroke to improve activities of daily living or maximal walking speed and should be considered in future guidelines. TRIAL REGISTRATION: ClinicalTrials.gov NCT01953549.


Asunto(s)
Terapia por Ejercicio/métodos , Aptitud Física/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Actividades Cotidianas , Adulto , Anciano , Evaluación de la Discapacidad , Prueba de Esfuerzo , Terapia por Ejercicio/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Terapia por Relajación , Índice de Severidad de la Enfermedad , Método Simple Ciego , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/efectos adversos , Resultado del Tratamiento , Caminata/fisiología
20.
Gait Posture ; 74: 194-199, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31550557

RESUMEN

BACKGROUND: The control of foot trajectory during swing phase is important to achieve safe clearance with the ground. Complexity of a physiological control system arises from the interaction of structural units and regulatory feedback loops that operate to enable the organism to adapt to a non-static environment. Diabetic polyneuropathy (DPN) impairs peripheral feedback inputs and alters ankle control during gait, which might affect toe clearance (ToC) parameters and its complexity, predisposing DPN-subjects to tripping and falling. RESEARCH QUESTION: How do different DPN-severity degrees change ToC trajectory and minimum ToC, and its complexity during gait of diabetic subjects? METHODS: 15 healthy controls and 69 diabetic subjects were assessed and classified into DPN-severity degrees by an expert fuzzy model: absent (n = 26), mild (n = 21) and severe (n = 22). Three-dimensional kinematics was measured during comfortable walking. ToC was the minimum vertical distance between the marker placed at the first metatarsal head and the ground during swing. Mean ToC, ToC standard deviation (SD) between trials, and sample entropy (SaEn) and standard deviation (SD) of ToC trajectory were calculated from the ToC temporal series. ANOVA and ANCOVA (with the walking speed as the covariate) and Bonferroni pairwise post-hoc tests (P < 0.05) were used to compare groups. RESULTS: Mean ToC and ToC SD did not show differences between groups (ANCOVA F = 0.436; df = 3; P = 0.705; F=1.719; df=3; P=0.170, respectively). ToC trajectory SD also did not show differences between groups (ANCOVA F = 3.98; df = 3; P = 0.755). Severe-DPN subjects showed higher ToC_Traj_SaEn than controls (ANCOVA F=2.60; df=3; P = 0.05). SIGNIFICANCE: Severe-DPN subjects showed a more complex pattern of overall foot-ankle trajectory in swing phase in comparison to controls, although did not present lower minimum ToC values. The higher complexity of ToC might lead to an increase in the motor system output (more strategies, increase in variability), resulting in a more unstable system and selected motor strategies.


Asunto(s)
Diabetes Mellitus/fisiopatología , Neuropatías Diabéticas/fisiopatología , Pie/fisiología , Marcha/fisiología , Caminata/fisiología , Adulto , Anciano , Análisis de Varianza , Fenómenos Biomecánicos , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
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