Determination of Body Composition in Community-Dwelling Older Adults With and Without Sarcopenia Using Data From Practical Measures.

Adequate body composition is essential for health, function, and independence in older adults. However, standard body composition assessments require complex and costly modalities, limiting their use for early detection of body composition changes and periodic follow-up. This study explored the ability of three practical measures-handgrip strength, five times sit-to-stand test, and upper limb loading during seated push-up test (ULL-SPUT)-to determine body composition in 109 older adults with and without sarcopenia. Participants (average age 76 years) were cross-sectionally measured for outcomes of the study. The ULL-SPUT and handgrip strength, but not the five times sit-to-stand test, significantly correlated with body composition (rs, r = .297-.827, p < .01). The ULL-SPUT, in combination with demographic data, could determine body composition up to 82%. Therefore, the ULL-SPUT may be a practical preliminary measure to identify older adults for whom standard body composition assessments and follow-up would prove timely and beneficial.

The determination of sarcopenia in older adults using a practical measure.

BACKGROUND: Many older adults are at risk of sarcopenia, a gradual loss of muscle mass affecting muscle strength and physical function, which can lead to adverse health consequences deteriorating their independence. However, the detection could be delayed due to the requirement of many measures, including a complex imaging modality. Thus, an exploration for a practical community- or home-based measure would be helpful to identify at-risk older adults and begin the timely management. OBJECTIVE: To explore the ability of the upper limb loading during a seated push-up test (ULL-SPUT) to determine the presence of sarcopenia in community-dwelling older adults. METHODS: Older adults (n= 110; 62 females, average age approximately 77 years) were cross-sectionally assessed for sarcopenia using standard measures (handgrip strength, appendicular skeletal muscle mass, and walking speed) and the ULL-SPUT. RESULTS: Data from standard measures indicated that 44 participants had sarcopenia. The ULL-SPUT index of < 16.9 kg/m2 for females (sensitivity = 86%, specificity = 78%, area under the receiver operating characteristic curve [AUC] = 0.85) and < 19.7 kg/m2 for males (sensitivity = 73%, specificity = 69%, AUC = 0.83) could optimally identify participants with sarcopenia. CONCLUSION: The ULL-SPUT index could be used to screen and monitor older adults with sarcopenia in various clinical, community, and home settings. This practical measure may be accomplished using a digital bathroom scale on a hard, even surface. Outcomes would identify an adult who should undergo further confirmation of sarcopenia through standard measures or the initiation of timely management to promote treatment effectiveness.

The seventh cervical vertebra is an appropriate landmark for thoracic kyphosis measures using distance from the wall.

Background: Hyperkyphosis is frequently found nowadays due to the change in current lifestyles and age-related system decline. A simple hyperkyphosis measurement can be made easily using the perpendicular distance from the landmark to the wall. However, the existing evidence applied two different landmarks [occiput and the seventh cervical vertebra (C7)] and the measurement using rulers was susceptible to error due to their misalignment. Objective: To assess an appropriate landmark for thoracic kyphosis measurement using distance from the wall (KMD), by comparing between occiput and C7, as measured using rulers and verified using data from a specially developed machine, the so-called infrared-gun kyphosis wall distance tool (IG-KypDisT), and the Cobb angles. Methods: Community-dwelling individuals with a risk of thoracic hyperkyphosis (age ≥10 years, n=43) were cross-sectionally assessed for their thoracic hyperkyphosis using the perpendicular distance from the landmarks, occiput and C7, to the wall using rulers and IG-KypDisT. Then the Cobb angles of these participants were measured within seven days. Results: The outcomes from both landmarks differed by approximately 0.8 cm (p= 0.084). The outcomes derived from C7 were more reliable (ICCs>0.93, p<0.001), with greater concurrent validity with the radiologic data (r= 0.738, p<0.001), with the overall variance predicted by the regression models for the Cobb angles being higher than that from the occiput (47-48% from C7 and 38-39% from occiput). The outcomes derived from rulers and IG-KypDisT showed no significant differences. Conclusion: The present findings support the reliability and validity of KMD assessments at C7 using rulers as a simple standard measure of thoracic hyperkyphosis that can be used in various clinical, community, and research settings.

The Use of a Single-Time Sit-To-Stand Test in Ambulatory Individuals With Spinal Cord Injury by Primary Health Care Providers.

Background: The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI). Objectives: This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional. Methods: Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers. Results: Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters. Conclusion: The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.

Ability of the Seventh Cervical Vertebra Wall Distance to Determine Mobility Deficits of Older Adults.

Thoracic hyperkyphosis could affect mobility and independence of older adults. However, there was no clear evidence on the use of the seventh cervical vertebra wall distance (C7WD), a practical measure for thoracic hyperkyphosis, to indicate mobility deficits relating to independence of these individuals. This study explored the ability of C7WD to determine mobility impairments in 104 older adults. Participants (average age of 74.1 ± 7.4 years) with various degree of thoracic kyphosis were cross-sectionally measured for their C7WD, mobility, and Cobb angle. The findings indicate that participants with thoracic hyperkyphosis (Cobb angle = 46.1 ± 5.2°) had significantly poorer mobility than those without thoracic hyperkyphosis (Cobb angle = 32.8 ± 5.9°, p < .05). A C7WD of ≥7.8 cm could indicate mobility deficits of the participants (sensitivity = 71%-92%, specificity = 75%-94%, and area under the curve >0.80). The findings confirm the ability of C7WD that could be clinically measured using rulers to indicate mobility deficits of older adults.

Validity and feasibility of a seated push-up test to indicate skeletal muscle mass in well-functioning older adults.

INTRODUCTION: Skeletal muscle mass (SMM) is a major component of the human body (> 30% of the body-weight) and plays crucial role in many bodily functions. However, SMM assessments require a complex and costly machine, which delays the ability to detect abnormalities related to SMM decline and, subsequently, reduces the effectiveness of the clinical management of older adults. PURPOSE: This study aimed to: 1) assess the correlation between upper limb loading during a seated push-up test (ULL-SPUT) and SMM (concurrent validity); 2) compare the SMM of participants who passed and failed a seated push-up test (SPUT; discriminant validity); and 3) explore the ability of a failed SPUT to identify older individuals with low SMM. METHODS: Participants (n = 40, age approximately 73 years) were cross-sectionally assessed for their SMM using a portable bioelectrical impedance analysis, and SPUTs were evaluated using digital push-up loading devices that were the size of clinical push-up boards, in three starting positions: 1) high; 2) ring, and 3) long sitting positions. RESULTS: The ULL-SPUT, especially in a ring sitting position, was significantly correlated to SMM (rs = 0.457-0.608, p < .005). The SMM and ULL-SPUT were significantly different between participants who passed and failed the SPUT (p < .05). Failure to complete the SPUT - that is, being unable to lift the body up from the floor during the test - showed an excellent ability to indicate participants with an SMM of < 28% of their body-weight (sensitivity > 83%, specificity > 82%, area under the curve = 0.93). CONCLUSIONS: The inability to lift the body up from the floor during sitting using the upper limbs can be used as a screening tool to indicate those with low SMM. Such a simple screening measure may enhance the distribution of healthcare services across various community- and home-based settings, particularly during the coronavirus (COVID-19) pandemic, when hospital services are limited for many individuals, including older adults.

Effects of four-week lower limb loading training with and without augmented feedback on mobility, walking device use, and falls among ambulatory individuals with spinal cord injury: a randomized controlled trial.

PURPOSE: To compare the effects of lower limb loading training (LLLT) with or without augmented loading feedback during stepping activity on mobility, walking device use, and falls among ambulatory individuals with chronic spinal cord injury (SCI). STUDY DESIGN: Randomized controlled trial (assessor-blinded) with prospective fall data follow-up, clinical trial registration (NCT03254797). METHODS: Forty-four ambulatory participants (22 participants/group) were prospectively monitored for their baseline fall data over six months, with baseline assessments for their mobility and walking device used after six months. Then participants involved in the LLLT programs with or without loading feedback according to their groups for 30 min/day, 5 days/week, over 4 weeks. Mobility outcomes were re-assessed at week two and week four, with prospective fall data monitoring over six months, and mobility measured thereafter. RESULTS: Mobility outcomes of the participants were significantly improved from their baseline ability, especially in those who were trained using augmented feedback (the difference in main outcome, timed up and go, between the groups was 1.8 s; 95% confidence interval = 1.0-3.5s). CONCLUSIONS: LLLT during stepping activity, especially with augmented loading feedback, could be applied effectively to promote mobility and safety of ambulatory individuals with chronic SCI (post-injury time of approximately four years).

A training program of bodyweight shifting and lower limb loading training during stepping activity significantly improved mobility, walking ability, and fall rates of ambulatory individuals with chronic spinal cord injury.The improvement in those who were trained using augmented loading feedback was significantly greater than those who were trained without feedback.Such training programs may be applied to distribute effective community-based rehabilitation and home healthcare services.

Ability to detect history of falls among individuals with spinal cord injury using upper limb loading during a seated push-up test.

BACKGROUND: A history of falls is an important risk factor for future falls, including for individuals with spinal cord injury (SCI) who often experience falls and subsequent injuries. This may be even more pronounced during the current COVID-19 pandemic because of the extreme shortage of hospital admission and restricted access to important services. Therefore, the ability of detecting a history of falls that can be applied to wheelchair users and ambulatory individuals with SCI in various settings are essential. AIM: To investigate the discriminative ability of three clinical measures-the handgrip (HG) test, Spinal Cord Independence Measure (SCIM) III and Upper Limb Loading During a Seated Push-Up Test (ULL-SPUT)-in discriminating individuals with SCI with and without a history of falls over the past six months. DESIGN: A 6-month retrospective observational cohort study. SETTING: Inpatient tertiary rehabilitation center. POPULATION: One hundred and fourteen wheelchair users and ambulatory individuals with SCI. METHODS: The participants were interviewed and assessed for their demographics, SCI characteristics and fall data over the past six months, with data confirmation from related events, their caregivers and medical records. Subsequently, they were assessed using the HG test, SCIM III, and ULL-SPUT. RESULTS: In total, 29 participants (25%) fell during the past six months (with the number of falls ranging from 1-20, with minor consequences after the falls). Among the three clinical measures assessed in this study, the ULL-SPUT data of faller participants were significantly higher than those of non-fallers (P<0.05). CONCLUSIONS: The limited rehabilitation length and increased staying home and social isolation prompted by the COVID-19 pandemic may have reduced the fall rates of the participants. The findings suggest a higher likelihood of falls among wheelchair users and ambulatory individuals with SCI who have good mobility as determined using ULL-SPUT data. CLINICAL REHABILITATION IMPACT: Apart from being an important rehabilitation strategy, the present findings suggest an additional benefit of ULL-SPUT to identify individuals with SCI with a likelihood of future falls. The measurement can be done easily using digital bathroom scales placing over a flat and smooth surface. Therefore, it would enable the timely initiation of fall prevention strategies in various clinical, community, home and research settings; particularly in this COVID-19 pandemic of limited beds and hospital services for these individuals.

Validity and feasibility of using a seated push-up test among community-dwelling older adults.

Background: Older individuals face a high risk of mobility and body composition decline, which can affect their independence. In light of a current uncertain healthcare situation created by the coronavirus (COVID-19) pandemic, healthcare paradigm has been shifted with increased demand for a practical measure to promote standard home healthcare services for all individuals, including older adults. Objective: This study explored the feasibility and validity of seated push-up tests (SPUTs) as clinical measures to reflect the body composition, muscle strength, and mobility among community-dwelling older individuals, aged ≥65 years (n=82). Methods: Participants were cross-sectionally assessed using SPUTs with various demanding forms, including the 1-time SPUT (1SPUT) along with its upper limb loading SPUT (ULL-SPUT), 5-time SPUT (5SPUT), 10-time SPUT (10SPUT), and 1-min SPUT (1minSPUT) and standard measures. Results: Participants who passed and failed a 1SPUT showed significant differences in the outcomes of all standard measures (p<0.05). The ULL-SPUT significantly correlated to all body composition, muscle strength, and mobility (r=0.247-0.785; p<0.05). Outcomes of 1minSPUT significantly correlated with muscle strength and mobility outcomes (r=0.306-0.526; p<0.05). Participants reported no adverse effects following the SPUTs. Conclusion: The findings suggest the use of the 1SPUT, ULL-SPUT, and 1minSPUT as practical measures to reflect the body composition, muscle strength, and mobility of older individuals, according to their functional levels. The tests may especially clinically benefit those with lower limb limitations and those in settings with limited space and equipment.

Outcomes of the five times sit-to-stand test could determine lower limb functions of ambulatory people with spinal cord injury only when assessed without hands.

Context/Objectives: Various clinical application of the five times sit-to-stand test (FTSST), with or without hands, may confound the outcomes to determine the lower limb functions and mobility of individuals with spinal cord injury (SCI). This study assessed the concurrent validity of the FTSST in ambulatory individuals with SCI who completed the test with or without hands as verified using standard measures for lower extremity motor scores (LEMS) and functional mobility necessary for independence and safety of these individuals.Design: Cross-sectional study.Setting: Tertiary rehabilitation centers and community hospitals.Participants: Fifty-six ambulatory individuals with motor incomplete SCI who were able to walk independently with or without a walking device over at least 10 m.Outcome Measures: Time to complete the FTSST with or without hands according to individuals' abilities, LEMS, and functional mobility.Results: Time to complete the FTSST showed moderate-to-strong correlation with the LEMS scores and all functional mobility tests (ρ = -0.38 to -0.71, P < 0.05), but only in those who performed the test without hands. By contrast, data of those who completed the FTSST with hands were significantly correlated only with the ankle muscle strength and the functional mobility measures that allow upper limb contribution in the tests (ρ = -0.40 to 0.52, P < 0.05).Conclusion: Upper limb involvement could confound the outcomes of the FTSST. The present findings suggest the use of FTSST without hands to determine the lower limb functions of ambulatory individuals with SCI.

The use of simple muscle strength tests to reflect body compositions among individuals with spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To investigate the correlation between simple muscle strength tests (including handgrip test and upper limb loading during a seated push-up test [ULL-SPUT]) and body compositions among individuals with spinal cord injury (SCI). SETTING: A tertiary rehabilitation center. METHODS: Twenty-four participants with SCI (average age of 40 years) were cross-sectionally assessed using handgrip test, ULL-SPUT, and body compositions (including skeletal muscle mass, bone mineral content, and fat mass) using dual-energy X-ray absorptiometry scan. RESULTS: The handgrip data had low-to-moderate correlation to body compositions of the arms (rs = 0.474-0.515, p < 0.05), while the ULL-SPUT data were low-to-excellently correlated to all body compositions of the arms, legs, and trunk (rs, r = 0.467-0.921, p < 0.05). CONCLUSIONS: The findings extend clinical benefit of a SPUT apart from being a rehabilitation strategy to promote mobility of individuals with SCI. Simple measurement of the ULL-SPUT, which can be done using digital bathroom scales placed on a hard and even surface, appears to be strongly correlated with body compositions in a small sample of predominantly middle age, normal weight, men with paraplegia. More research is required to understand whether this test can be used clinically to assess body compositions in a more diverse SCI population, and whether it is responsive to changes in body compositions over time.

The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury.

BACKGROUND: Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability. OBJECTIVE: This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily ( n = 49 ). METHODS: All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance. RESULTS: The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability ( p < 0 . 05 ). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance ( ρ =- 0 . 351 to - 0.493, p < 0 . 05 ). CONCLUSION: The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.

External Devices Among Individuals With Spinal Cord Injury From a Developing Country.

OBJECTIVE: The aim of this study was to explore the proportion, number, and type of external devices (including mobility devices, ambulatory aides, and orthotics) possessed and used by individuals with spinal cord injury (SCI) from a developing country. DESIGN: This was a cross-sectional study. PARTICIPANTS: A total of 163 participants with SCI from several rural communities in a developing country participated in the study from June 2018 to August 2019. METHODS: The participants were interviewed and assessed for their SCI characteristics and the external devices (i.e., mobility devices, ambulatory aides, and orthotics) they possessed and used in their daily living. RESULTS: Most participants (85%), who lived in rural communities with a family income of less than $3167 per year, possessed external devices (one to five types), and 80% of all participants actually used the devices (one to three types) in their daily living. Most participants with motor-complete SCI used a single device, especially a manual wheelchair, whereas those with mild lesion severity used multiple devices for their daily activities, particularly a standard walker. CONCLUSION: Owing to budget and environmental constraints, the external devices used by individuals with SCI from a developing country are different from those reported in a developed country. The findings provide particular insights into the management of external devices for these individuals of a developing country.

Various Surfaces Benefited Functional Outcomes and Fall Incidence in Individuals With Spinal Cord Injury: A Randomized Controlled Trial With Prospective Data Follow-up.

OBJECTIVES: To compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI). DESIGN: A randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up. SETTING: Tertiary rehabilitation centers and several communities. PARTICIPANTS: Independent ambulatory individuals (N=54) with SCI who walked with or without a walking device. INTERVENTION: Participants were randomly arranged into a control group (overground walking training, n=26) or experimental group (walking training over a WTDS, n=28) for 30 min/d, 5 d/wk over 4 weeks. MAIN OUTCOME MEASURES: The 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months. RESULTS: Participants who walked with an average speed of 0.52 m/s and postinjury time >7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (P<.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n=5, 18%) fewer than those in the control group (n=12, 46%). CONCLUSIONS: Being at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.

The use of lower limb loading ability as an indicator for independence and safety in ambulatory individuals with spinal cord injury.

BACKGROUND: Data relating to weight-bearing or lower limb loading ability (LLLA) have been reported wildly in several individuals, mostly with unilateral impairments, but not in ambulatory individuals with spinal cord injury (SCI) who have bilateral sensorimotor deterioration. AIM: To assess the LLLA of ambulatory individuals with SCI who walk independently with and without a walking device, and explore the optimal threshold of the LLLA to determine the independence and safety of these individuals. DESIGN: Cross-sectional study. SETTING: Tertiary rehabilitation centers and communities. POPULATION: Ninety ambulatory participants with SCI. METHODS: Participants were assessed for their LLLA during stepping of the contralateral leg using a digital load cell. In addition, they were assessed using functional mobility tests and interviewed for fall data over the past six months. RESULTS: Participants who walked independently with or without a walking device had an average LLLA of at least 79% of their bodyweight. In addition, the amount of LLLA at least 94-95% of the bodyweight had moderate diagnostic properties to indicate the independence and safety of these individuals (sensitivity =68-77%, specificity =66-81%, and AUC=0.73-0.80). CONCLUSIONS: The clear and objective data relating to LLLA can be used as a critical indicator for the safe and steady mobility, specifically for ambulatory individuals with SCI. These data can be used as an optimal threshold in rehabilitation training, screening and monitoring of their functional alteration over time in clinical, community, and home-based settings. CLINICAL REHABILITATION IMPACT: The LLLA of at least 79% of the bodyweight could determine the ability of independent walking with a walking device, while an LLLA of at least 94-95% of the bodyweight could indicate the ability of walking without a walking device and no multiple falls. These data can be used as an optimal target in rehabilitation training, screening and monitoring of functional alteration over time in various clinical and home-based settings, specifically for ambulatory individuals with SCI.

Immediate effects of lower limb loading exercise during stepping with and without augmented loading feedback on mobility of ambulatory individuals with spinal cord injury: a single-blinded, randomized, cross-over trial.

STUDY DESIGN: Single-blinded, randomized, cross-over design. OBJECTIVES: To compare the immediate effects of bodyweight shifting and lower limb loading (LLL) exercise during stepping with and without augmented loading feedback, followed by overground walking, on the mobility of ambulatory individuals with spinal cord injury (SCI). SETTING: Academic laboratory center. METHODS: Thirty participants with SCI were trained using a single intervention session consisting of repetitive bodyweight shifting and LLL exercises during stepping with or without external feedback (10 min/leg) followed by overground walking (10 min) with a 2-week washout period, in a random sequence. The timed up-and-go test (TUG) (primary outcome), 10-m walk test (10MWT), five times sit-to-stand test (FTSST), and maximal LLL were measured 1 day before and immediately after each training session. RESULTS: Significant improvement was found following both training sessions, excepting the TUG and LLL of the less-affected leg, where improvement was found only after training using augmented feedback. Moreover, the improvement following the training with feedback was significantly greater than that after training without feedback. The mean (95% CI) between-group differences for the TUG = 1.9 [0.6-3.3]s, 10MWT = 0.1 [0.0-0.1]m/s, FTSST = 1.0 [1.5-4.8]s, LLL = 3.1 [1.5-4.8]-2.8 [0.8-4.9]%bodyweight, p < 0.05. CONCLUSIONS: The training programs immediately enhanced the mobility of ambulatory individuals with chronic SCI (post-injury time >6 years), particularly the training with augmented loading feedback. The findings offer another effective rehabilitation strategy that can be applied in various clinical and home-based settings.

Influence of timing protocols and distance covered on the outcomes of the 10-meter walk test.

Background: The 10-meter walk test (10MWT) is commonly used to reflect a walking speed, health status, and functional ability of many individuals. However, the test is currently applied using various timing protocols and distance covered that may affect data interpretation with a standard value, and comparisons among the studies. Objective: This study investigated the influence of timing protocols and distance covered on the outcomes of the 10MWT in 78 participants who walked at various speeds, including healthy adults (n = 33), healthy elderly (n = 29), and clinical samples with impaired walking ability (walked slower than 0.8 m/s, n = 16). Methods: The participants were timed while they walked (1) over a 10-meter walkway using static and flying starts; and (2) over 4 and 10 meters using a flying start. The comparisons for outcomes of the timing protocols (static and flying starts), and distance covered (4 and 10 meters) for each group of participants was executed using the dependent samples t-test. Results: A walking speed using a static start was slower than that using a flying start approximately 0.05-0.11 m/s for each group (p < 0.001). On the contrary, the outcomes of a flying start over 4 and 10 meters showed no significant differences (p > 0.05). Conclusions: The findings clearly confirmed the influence of timing protocols on the outcomes of the 10MWT in individuals with various walking speeds, and a flying start over 4 meters in the middle of a 10-meter walkway can be applied as an alternative protocol of the 10MWT when area limits.

Stepping training with external feedback relating to lower limb support ability effectively improved complex motor activity in ambulatory patients with stroke: a randomized controlled trial.

BACKGROUND: Lower limb support ability is important for steady and efficient mobility, but previous data commonly involved training during double stance positions, with or without external feedback, using a complex and costly machine. AIM: To compare the effects of stepping training with or without external feedback in relation to the lower limb support ability of the affected limb on the functional ability necessary for independence in individuals with stroke. DESIGN: A single-blinded, randomized controlled trial. SETTING: Tertiary rehabilitation centers. POPULATION: Ambulatory participants with stroke who walked independently over at least 10 meters with or without walking devices. METHODS: Thirty-six participants were randomly arranged to be involved in a program of stepping training with or without external feedback related to the lower limb support ability of the affected limb (18 participants/group) for 30 minutes, followed by overground walking training for 10 minutes, 5 days/week over 4 weeks. The outcomes, including the lower limb support ability of the affected legs during stepping, functional ability and spatial walking data, were assessed prior to training, immediately after the first training session, and after 2- and 4-week training. RESULTS: Participants demonstrated significant improvement in the amount of lower limb support ability, immediately after the first training with external feedback. Then, these participants showed further improvement in both the amount and duration of lower limb support ability, as well as the Timed Up and Go data after 2 and 4 weeks of training (P<0.05). This improvement was not found following control training. CONCLUSIONS: The external feedback relating to lower limb support ability during stepping training effectively improved the movement stability and complex motor activity of ambulatory individuals with stroke who had long post-stroke time (approximately 3 years). CLINICAL REHABILITATION IMPACT: Stepping training protocols and feedback can be easily applied in various settings using the amount of body weight from an upright digital bathroom scale. Thus, the findings offer an alternative rehabilitation strategy for clinical, community and home-based settings for stroke individuals.

Five times sit-to-stand test for ambulatory individuals with spinal cord injury: a psychometric study on the effects of arm placements.

STUDY DESIGN: A psychometric study. OBJECTIVES: To investigate the reliability and the concurrent validity of the five times sit-to-stand test (FTSST) during various arm placement conditions in ambulatory participants with spinal cord injury (SCI). In addition, the difficulty of the FTSST during various arm placement conditions was compared using the number, characteristics, and physical ability of those who could complete the conditions. SETTING: Rehabilitation centers and communities in Thailand. METHODS: Eighty-two participants were assessed for their physical ability and ability to complete the FTSST in four arm placement conditions, namely, arms on a walking device, arms on knees, arms free by sides, and arms crossed over the chest, according to their ability and in random order. RESULTS: The outcomes for all the FTSST conditions had excellent rater and test-retest reliability with a modest to strong correlation with their physical ability (ρ = -0.39 to -0.72), and it is especially high for the condition with arms by sides. All participants could complete the conditions with arms on a walking device, and two-thirds of them could execute the other conditions. The physical ability of these individuals was significantly better, with the number of those with mild lesion severity being greater than those who could execute the FTSST with arms on a walking device (p <0.01). CONCLUSIONS: Arm placements affected the psychometric properties and the ability to complete the FTSST of the participants. The current findings recommend the FTSST for ambulatory individuals with SCI using arms free by sides.

Dual-Task Obstacle Crossing Training Could Immediately Improve Ability to Control a Complex Motor Task and Cognitive Activity in Chronic Ambulatory Individuals With Spinal Cord Injury.

Background: The effectiveness of dual-task training has been reported in individuals with cognitive impairments. To date, there is no clear evidence on the incorporation of dual-task training in ambulatory individuals with spinal cord injury (SCI) who have intact cognitive functions but have various degrees of sensorimotor dysfunction. Objectives: To compare the immediate effects of dual-task obstacle crossing (DTOC) and single-task obstacle crossing (STOC) training on functional and cognitive abilities in chronic ambulatory participants with SCI. Methods: This is a randomized 2 × 2 crossover design with blinded assessors. Twenty-two participants were randomly trained using a 30-minute DTOC and STOC training program with a 2-day washout period. Outcomes, including 10-Meter Walk Tests (single- and dual-task tests), percent of Stroop Color and Word Test task errors, Timed Up and Go Test (TUG), and five times sit-to-stand test, were measured immediately before and after each training program. Results: Participants showed significant improvement in all outcomes following both training programs (p < .05), except percent of Stroop Color and Word Test task errors after STOC training. Obvious differences between the training programs were found for the percent of Stroop task errors and TUG (ps = .014 and .06). Conclusion: Obstacle crossing is a demanding task, thus the obvious improvement was found immediately after both training programs in participants with long post-injury time (approximately 5 years). However, the findings primarily suggest the superior effects of DTOC over STOC on a complex motor task and cognitive activity. A further randomized control trial incorporating a complex dual-task test is needed to strengthen evidence for the benefit of DTOC for these individuals.