High Level Mobility Training in Ambulatory Patients with Acquired Non-Progressive Central Neurological Injury: a Feasibility Study.

The purpose of this study was to test the feasibility and safety of High-Level Mobility (HLM) training on adults with Acquired Brain Injury (ABI). Our hypotheses were that HLM training would be feasible and safe. This study was a pilot randomized control trial with a Simple Skill Group (SSG) and a Complex Skill Group (CSG). Both groups received 12 sessions over 8 weeks and completed 4 testing sessions over 16 weeks. The SSG focused on locomotion, while CSG focused on the acquisition of running. Feasibility was assessed in terms of process, resources, management, and scientific metrics, including safety. Among the 41 participants meeting inclusion criteria, 28 consented (CSG, n = 13, SSG, n = 15), 20 completed the assigned protocol and 8 withdrew (CSG n = 4, SSG n = 4). Adherence rate to assigned protocol was 100%. There were two Adverse Events (AEs), 1 over 142 SSG sessions and 1 over 120 CSG sessions. The AE Odd Ratio (OR) (CSG:SSG) was 1.18 (95% CI: 0.07, 19.15). The data support our hypotheses that HLM training is feasible and safe on ambulatory adults with ABI.

Validity and reliability of the 20-m run, horizontal leap, and four-bound tests measuring high-level mobility in neurologically impaired patients.

BACKGROUND: High-level mobility (HLM) training including running forms an integral part of physical rehabilitation for neurologically impaired patients. OBJECTIVE: This study examines the validity and reliability of three quickly administrable measures of HLM, namely, the 20-m run, horizontal leap, and four-bound tests in patients with neurological disorders. METHODS: This is a retrospective data audit of 62 patients (23 women, 37.1%; 39 men, 62.9%) participating in the HLM (running retraining) task. All participants were recovering from neurological conditions such as stroke, brain injury, brain/spinal tumour, Guillain-Barré syndrome, and cerebral palsy complications. RESULTS: High levels of test-retest reliability of the investigated tests (interclass correlation coefficient > 0.95) were obtained. The 95% minimum detectable changes were as follows: 20-m run, 1.9 seconds; horizontal leap, 0.20 m; four-bound test, 0.57 m. The area under the receiver-operated characteristic curve was 0.96 for the 20-m run, 0.90 for the horizontal leap, and 0.91 for the four-bound test, which suggests high validity of the tests to discriminate between participants who were classified as "running" and those as "not running". Participants performing at < 7.2 seconds for the 20-m run test or ≥ 0.75 m for the horizontal leap test or 4.0 m for the four-bound test were most likely classified as running. CONCLUSION: The 20-m run, horizontal leap, and four-bound tests are valid and reliable objective measures of HLM when administered in people with neurological conditions.

The effect of exercise on high-level mobility in individuals with neurodegenerative disease: a systematic literature review.

OBJECTIVE: To investigate the effect of exercise on high-level mobility (i.e. mobility more advanced than independent level walking) in individuals with neurodegenerative disease. DATA SOURCES: A systematic literature search was conducted in Medline, CINAHL, Scopus, SportDiscus and PEDro. STUDY SELECTION: Randomised controlled trials of exercise interventions for individuals with neurodegenerative disease, with an outcome measure that contained high-level mobility items were included. High-level mobility items included running, jumping, bounding, stair climbing and backward walking. Outcome measures with high-level mobility items include the High Level Mobility Assessment Tool (HiMAT); Dynamic Gait Index; Rivermead Mobility Index (RMI) or modified RMI; Functional Gait Assessment and the Functional Ambulation Category. STUDY APPRAISAL: Quality was evaluated with the Cochrane Risk of Bias Tool. RESULTS: Twenty-four studies with predominantly moderate to low risk of bias met the review criteria. High-level mobility items were included within primary outcome measures for only two studies and secondary outcome measures for 22 studies. Eight types of exercise interventions were investigated within which high-level mobility tasks were not commonly included. In the absence of outcome measures or interventions focused on high-level mobility, findings suggest some benefit from treadmill training for individuals with multiple sclerosis or Parkinson's disease. Progressive resistance training for individuals with multiple sclerosis may also be beneficial. With few studies on other neurodegenerative diseases, further inferences cannot be made. CONCLUSION: Future studies need to specifically target high-level mobility in the early stages of neurodegenerative disease and determine the impact of high-level mobility interventions on community participation and maintenance of an active lifestyle. Systematic review registration number PROSPERO register for systematic reviews (registration number: CRD42016050362).

The effect of a running intervention on running ability and participation in children with cerebral palsy: a randomized controlled trial.

PURPOSE: The purpose of this study is to evaluate effects of a running intervention on running ability and participation in children with cerebral palsy. MATERIALS AND METHOD: Children with cerebral palsy (9-18 years) with Gross Motor Function Classification System levels I-III were randomly assigned to a 12-week running intervention or usual care. Primary outcomes included improvement in running ability (assessed by Goal Attainment Scaling, high level mobility (assessed by the High-Level Mobility Assessment Tool) and participation (assessed by the Participation and Environment Measure for Children and Youth). Secondary outcomes were aerobic and anaerobic fitness and agility. Blinded assessments took place at baseline and 12 weeks. Regression analysis adjusting for baseline differences was used to determine between group differences. RESULTS: Forty-two participants (mean age 12.5 years, SD 2.8 years; 15 female) completed the study. Statistically significant group differences at 12-weeks were found for improvements in running ability (86% treatment group versus 0% control group achieved or exceeded their running goals, p < 0.001), and participation in the school environment (Participation and Environment Measure mean difference 1.18: 95%CI 1.00-1.39, p = 0.045). CONCLUSION: A 12-week individualized running training skills intervention results in achievement of running ability goals and participation in the school environment in children with cerebral palsy. Implications for Rehabilitation Children with cerebral palsy who can walk unaided demonstrate impairments in higher level mobility such as running. Running is a motor skill that can be trained in children with cerebral palsy. Individually tailored running skills intervention, delivered in a group context can improve goal-identified running ability and translate into a higher frequency of participation in school activities.

White matter alterations and their associations with motor function in young adults born preterm with very low birth weight.

Very low birth weight (VLBW: ≤ 1500 g) individuals have an increased risk of white matter alterations and neurodevelopmental problems, including fine and gross motor problems. In this hospital-based follow-up study, the main aim was to examine white matter microstructure and its relationship to fine and gross motor function in 31 VLBW young adults without cerebral palsy compared with 31 term-born controls, at mean age 22.6 ± 0.7 years. The participants were examined with tests of fine and gross motor function (Trail Making Test-5: TMT-5, Grooved Pegboard, Triangle from Movement Assessment Battery for Children-2: MABC-2 and High-level Mobility Assessment Tool: HiMAT) and diffusion tensor imaging (DTI). Probabilistic tractography of motor pathways of the corticospinal tract (CST) and corpus callosum (CC) was performed. Fractional anisotropy (FA) was calculated in non-crossing (capsula interna in CST, body of CC) and crossing (centrum semiovale) fibre regions along the tracts and examined for group differences. Associations between motor test scores and FA in the CST and CC were investigated with linear regression. Tract-based spatial statistics (TBSS) was used to examine group differences in DTI metrics in all major white matter tracts. The VLBW group had lower scores on all motor tests compared with controls, however, only statistically significant for TMT-5. Based on tractography, FA in the VLBW group was lower in non-crossing fibre regions and higher in crossing fibre regions of the CST compared with controls. Within the VLBW group, poorer fine motor function was associated with higher FA in crossing fibre regions of the CST, and poorer bimanual coordination was additionally associated with lower FA in crossing fibre regions of the CC. Poorer gross motor function was associated with lower FA in crossing fibre regions of the CST and CC. There were no associations between motor function and FA in non-crossing fibre regions of the CST and CC within the VLBW group. In the TBSS analysis, the VLBW group had lower FA and higher mean diffusivity compared with controls in all major white matter tracts. The findings in this study may indicate that the associations between motor function and FA are caused by other tracts crossing the CST and CC, and/or by alterations in the periventricular white matter in the centrum semiovale. Some of the associations were in the opposite direction than hypothesized, thus higher FA does not always indicate better function. Furthermore, widespread white matter alterations in VLBW individuals persist into young adulthood.

Construct validity of Comprehensive High-Level Activity Mobility Predictor (CHAMP) for male servicemembers with traumatic lower-limb loss.

This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP) as a measure of high-level mobility in servicemembers (SMs) with traumatic lower-limb loss (LLL). The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT) as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP) as a measure of basic prosthetic mobility. The known group methods construct validity examined disparities in high-level mobility capability among SMs with different levels of LLL. The CHAMP score demonstrated a strong positive relationship between 6MWT distance (r = 0.80, p < 0.001) and AMP score (r = 0.87, p < 0.001), respectively. In addition, the CHAMP can discriminate between different levels of LLL. Study findings support the CHAMP as a valid performance-based assessment instrument of high-level mobility for SMs with traumatic LLL.

Factors related to high-level mobility in male servicemembers with traumatic lower-limb loss.

The purpose of this study was to examine the possible relationship between factors modifiable by rehabilitation interventions (rehabilitation factors), other factors related to lower-limb loss (other factors), and high-level mobility as measured by the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in servicemembers (SMs) with traumatic lower-limb loss. One-hundred eighteen male SMs with either unilateral transtibial amputation (TTA), unilateral transfemoral amputation (TFA), or bilateral lower-limb amputation (BLLA) participated. Stepwise regression analysis was used to develop separate regression models of factors predicting CHAMP score. Regression models containing both rehabilitation factors and other factors explained 81% (TTA), 36% (TFA), and 91% (BLLA) of the variance in CHAMP score. Rehabilitation factors such as lower-limb strength and dynamic balance were found to be significantly related to CHAMP score and can be enhanced with the appropriate intervention. Further, the findings support the importance of salvaging the knee joint and its effect on high-level mobility capabilities. Lastly, the J-shaped energy storage and return feet were found to improve high-level mobility for SMs with TTA. These results could help guide rehabilitation and aid in developing appropriate interventions to assist in maximizing high-level mobility capabilities for SMs with traumatic lower-limb loss.

Motor skills at 23 years of age in young adults born preterm with very low birth weight.

BACKGROUND: Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents. AIM: To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group. STUDY DESIGN: A geographically based follow-up study of a VLBW group and a control group. SUBJECTS: Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age. OUTCOME MEASURES: Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT). RESULTS: VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p < 0.001). Mean total Movement ABC-2 score was 69.7 ± 20.2 in the VLBW group compared with 74.1 ± 14.4 in the control group (p = 0.017). Differences were also seen in manual dexterity and balance. Additionally, HiMAT showed reduced balance and speed in gross motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same. CONCLUSION: VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood.