The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke.

PubMed

Peurala, Sinikka H; Tarkka, Ina M; Pitkänen, Kauko; Sivenius, Juhani

2005-08-01

To compare body weight-supported exercise on a gait trainer with walking exercise overground. Randomized controlled trial. Rehabilitation hospital. Forty-five ambulatory patients with chronic stroke. Patients were randomized to 3 groups: (1) gait trainer exercise with functional electric stimulation (GTstim), (2) gait trainer exercise without stimulation (GT), and (3) walking overground (WALK). All patients practiced gait for 15 sessions during 3 weeks (each session, 20 min), and they received additional physiotherapy 55 minutes daily. Ten-meter walk test (10MWT), six-minute walk test (6MWT), lower-limb spasticity and muscle force, postural sway tests, Modified Motor Assessment Scale (MMAS), and FIM instrument scores were recorded before, during, and after the rehabilitation and at 6 months follow-up. The mean walking distance using the gait trainer was 6900+/-1200 m in the GTstim group and 6500+/-1700 m in GT group. In the WALK group, the distance was 4800+/-2800 m, which was less than the walking distance obtained in the GTstim group (P=.027). The body-weight support was individually reduced from 30% to 9% of the body weight over the course of the program. In the pooled 45 patients, the 10MWT (P<.001), 6MWT (P<.001), MMAS (P<.001), dynamic balance test time (P<.001), and test trip (P=.005) scores improved; however, no differences were found between the groups. Both the body weight-supported training and walking exercise training programs resulted in faster gait after the intensive rehabilitation program. Patients' motor performance remained improved at the follow-up.

A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency

PubMed Central

Kapadia, Naaz; Masani, Kei; Catharine Craven, B.; Giangregorio, Lora M.; Hitzig, Sander L.; Richards, Kieva; Popovic, Milos R.

2014-01-01

Background Multi-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury (SCI). Objective To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design. Methods Individuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and after 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected. Results Spinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Irrespective of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups. Conclusions Task-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Further randomized controlled trials, involving a large number of participants are needed, to verify if FES-assisted treadmill training is superior to aerobic and strength training. PMID:25229735

Exoskeleton Training May Improve Level of Physical Activity After Spinal Cord Injury: A Case Series

PubMed Central

Wade, Rodney; Sumrell, Ryan; Villadelgado, Lynette; Khalil, Refka E.; Lavis, Timothy

2017-01-01

Objectives: To determine whether the use of a powered exoskeleton can improve parameters of physical activity as determined by walking time, stand up time, and number of steps in persons with spinal cord injury (SCI). Methods: Three men with complete (1 C5 AIS A and 2 T4 AIS A) and one man with incomplete (C5 AIS D) SCI participated in a clinical rehabilitation program. In the training program, the participants walked once weekly using a powered exoskeleton (Ekso) for approximately 1 hour over the course of 10 to 15 weeks. Walking time, stand up time, ratio of walking to stand up time, and number of steps were determined. Oxygen uptake (L/min), energy expenditure, and body composition were measured in one participant after training. Results: Over the course of 10 to 15 weeks, the maximum walking time increased from 12 to 57 minutes and the number of steps increased from 59 to 2,284 steps. At the end of the training, the 4 participants were able to exercise for 26 to 59 minutes. For one participant, oxygen uptake increased from 0.27 L/min during rest to 0.55 L/min during walking. Maximum walking speed was 0.24 m/s, and delta energy expenditure increased by 1.4 kcal/min during walking. Body composition showed a modest decrease in absolute fat mass in one participant. Conclusion: Exoskeleton training may improve parameters of physical activity after SCI by increasing the number of steps and walking time. Other benefits may include increasing energy expenditure and improving the profile of body composition. PMID:29339900

Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up.

PubMed

Eggenberger, Patrick; Theill, Nathan; Holenstein, Stefan; Schumacher, Vera; de Bruin, Eling D

2015-01-01

About one-third of people older than 65 years fall at least once a year. Physical exercise has been previously demonstrated to improve gait, enhance physical fitness, and prevent falls. Nonetheless, the addition of cognitive training components may potentially increase these effects, since cognitive impairment is related to gait irregularities and fall risk. We hypothesized that simultaneous cognitive-physical training would lead to greater improvements in dual-task (DT) gait compared to exclusive physical training. Elderly persons older than 70 years and without cognitive impairment were randomly assigned to the following groups: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Gait variables, functional fitness (Short Physical Performance Battery, 6-minute walk), and fall frequencies were assessed at baseline, after 3 months and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were carried out. Eighty-nine participants were randomized to three groups initially; 71 completed the training and 47 were available at 1-year follow-up. DANCE/MEMORY showed a significant advantage compared to PHYS in DT costs of step time variability at fast walking (P=0.044). Training-specific gait adaptations were found on comparing DANCE and MEMORY: DANCE reduced step time at fast walking (P=0.007) and MEMORY reduced gait variability in DT and DT costs at preferred walking speed (both trend P=0.062). Global linear time effects showed improved gait (P<0.05), functional fitness (P<0.05), and reduced fall frequency (-77%, P<0.001). Only single-task fast walking, gait variability at preferred walking speed, and Short Physical Performance Battery were reduced at follow-up (all P<0.05 or trend). Long-term multicomponent cognitive-physical and exclusive physical training programs demonstrated similar potential to counteract age-related decline in physical functioning.

Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up

PubMed Central

Eggenberger, Patrick; Theill, Nathan; Holenstein, Stefan; Schumacher, Vera; de Bruin, Eling D

2015-01-01

Background About one-third of people older than 65 years fall at least once a year. Physical exercise has been previously demonstrated to improve gait, enhance physical fitness, and prevent falls. Nonetheless, the addition of cognitive training components may potentially increase these effects, since cognitive impairment is related to gait irregularities and fall risk. We hypothesized that simultaneous cognitive–physical training would lead to greater improvements in dual-task (DT) gait compared to exclusive physical training. Methods Elderly persons older than 70 years and without cognitive impairment were randomly assigned to the following groups: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Gait variables, functional fitness (Short Physical Performance Battery, 6-minute walk), and fall frequencies were assessed at baseline, after 3 months and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were carried out. Results Eighty-nine participants were randomized to three groups initially; 71 completed the training and 47 were available at 1-year follow-up. DANCE/MEMORY showed a significant advantage compared to PHYS in DT costs of step time variability at fast walking (P=0.044). Training-specific gait adaptations were found on comparing DANCE and MEMORY: DANCE reduced step time at fast walking (P=0.007) and MEMORY reduced gait variability in DT and DT costs at preferred walking speed (both trend P=0.062). Global linear time effects showed improved gait (P<0.05), functional fitness (P<0.05), and reduced fall frequency (−77%, P<0.001). Only single-task fast walking, gait variability at preferred walking speed, and Short Physical Performance Battery were reduced at follow-up (all P<0.05 or trend). Conclusion Long-term multicomponent cognitive–physical and exclusive physical training programs demonstrated similar potential to counteract age-related decline in physical functioning. PMID:26604719

NeuroRecovery Network provides standardization of locomotor training for persons with incomplete spinal cord injury.

PubMed

Morrison, Sarah A; Forrest, Gail F; VanHiel, Leslie R; Davé, Michele; D'Urso, Denise

2012-09-01

To illustrate the continuity of care afforded by a standardized locomotor training program across a multisite network setting within the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Single patient case study. Two geographically different hospital-based outpatient facilities. This case highlights a 25-year-old man diagnosed with C4 motor incomplete spinal cord injury with American Spinal Injury Association Impairment Scale grade D. Standardized locomotor training program 5 sessions per week for 1.5 hours per session, for a total of 100 treatment sessions, with 40 sessions at 1 center and 60 at another. Ten-meter walk test and 6-minute walk test were assessed at admission and discharge across both facilities. For each of the 100 treatment sessions percent body weight support, average, and maximum treadmill speed were evaluated. Locomotor endurance, as measured by the 6-minute walk test, and overground gait speed showed consistent improvement from admission to discharge. Throughout training, the patient decreased the need for body weight support and was able to tolerate faster treadmill speeds. Data indicate that the patient continued to improve on both treatment parameters and walking function. Standardization across the NRN centers provided a mechanism for delivering consistent and reproducible locomotor training programs across 2 facilities without disrupting training or recovery progression. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program.

PubMed

Rodgers, M M; Mulcare, J A; King, D L; Mathews, T; Gupta, S C; Glaser, R M

1999-07-01

Individuals who have multiple sclerosis (MS) typically experience problems with physical activities such as walking, resulting from the combined effects of skeletal muscle weakness, sensory disturbances, spasticity, gait ataxia, and reduction in aerobic capacity. The aim of this study was to determine whether a 6-mo exercise program designed for aerobic conditioning might also affect gait abnormalities in individuals with MS. Subjects included 18 individuals with MS who presented a range of disability. Passive range of motion (PROM) in the lower limbs was measured and gait analyzed before and after exercise conditioning. Three-dimensional kinematics, ground reaction forces (GRF), and electromyographic information were acquired as subjects walked at self-selected velocities. Hip PROM increased following conditioning. Mean walking velocity, cadence, and posterior shear GRF (push-off force) decreased. During walking, maximum ankle dorsiflexion decreased and ankle plantarflexion increased. Total knee flexion/extension range during the walking cycle decreased slightly as did maximum hip extension. Results suggest this 6-mo training program had minimal effect on gait abnormalities.

Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation

PubMed Central

Rábago, Christopher A.; Rylander, Jonathan H.; Dingwell, Jonathan B.; Wilken, Jason M.

2016-01-01

Background and Purpose Roughly 50% of individuals with lower limb amputation report a fear of falling and fall at least once a year. Perturbation-based gait training and the use of virtual environments have been shown independently to be effective at improving walking stability in patient populations. An intervention was developed combining the strengths of the 2 paradigms utilizing continuous, walking surface angle oscillations within a virtual environment. This case report describes walking function and mediolateral stability outcomes of an individual with a unilateral transfemoral amputation following a novel perturbation-based gait training intervention in a virtual environment. Case Description The patient was a 43-year-old male veteran who underwent a right transfemoral amputation 7+ years previously as a result of a traumatic blast injury. He used a microprocessor-controlled knee and an energy storage and return foot. Outcomes Following the intervention, multiple measures indicated improved function and stability, including faster self-selected walking speed and reduced functional stepping time, mean step width, and step width variability. These changes were seen during normal level walking and mediolateral visual field or platform perturbations. In addition, benefits were retained at least 5 weeks after the final training session. Discussion The perturbation-based gait training program in the virtual environment resulted in the patient's improved walking function and mediolateral stability. Although the patient had completed intensive rehabilitation following injury and was fully independent, the intervention still induced notable improvements to mediolateral stability. Thus, perturbation-based gait training in challenging simulated environments shows promise for improving walking stability and may be beneficial when integrated into a rehabilitation program. PMID:27277497

Locomotor training using an overground robotic exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, performance and safety.

PubMed

Gagnon, Dany H; Escalona, Manuel J; Vermette, Martin; Carvalho, Lívia P; Karelis, Antony D; Duclos, Cyril; Aubertin-Leheudre, Mylène

2018-03-01

For individuals who sustain a complete motor spinal cord injury (SCI) and rely on a wheelchair as their primary mode of locomotion, overground robotic exoskeletons represent a promising solution to stand and walk again. Although overground robotic exoskeletons have gained tremendous attention over the past decade and are now being transferred from laboratories to clinical settings, their effects remain unclear given the paucity of scientific evidence and the absence of large-scale clinical trials. This study aims to examine the feasibility of a locomotor training program with an overground robotic exoskeleton in terms of recruitment, attendance, and drop-out rates as well as walking performance, learnability, and safety. Individuals with a SCI were invited to participate in a 6 to 8-week locomotor training program with a robotic exoskeleton encompassing 18 sessions. Selected participants underwent a comprehensive screening process and completed two familiarization sessions with the robotic exoskeleton. The outcome measures were the rate of recruitment of potential participants, the rate of attendance at training sessions, the rate of drop-outs, the ability to walk with the exoskeleton, and its progression over the program as well as the adverse events. Out of 49 individuals who expressed their interest in participating in the study, only 14 initiated the program (recruitment rate = 28.6%). Of these, 13 individuals completed the program (drop-out rate = 7.1%) and attended 17.6 ± 1.1 sessions (attendance rate = 97.9%). Their greatest standing time, walking time, and number of steps taken during a session were 64.5 ± 10.2 min, 47.2 ± 11.3 min, and 1843 ± 577 steps, respectively. During the training program, these last three parameters increased by 45.3%, 102.1%, and 248.7%, respectively. At the end of the program, when walking with the exoskeleton, most participants required one therapist (85.7%), needed stand-by or contact-guard assistance (57.1%), used forearm crutches (71.4%), and reached a walking speed of 0.25 ± 0.05 m/s. Five participants reported training-related pain or stiffness in the upper extremities during the program. One participant sustained bilateral calcaneal fractures and stopped the program. This study confirms that larger clinical trials investigating the effects of a locomotor training program with an overground robotic exoskeleton are feasible and relatively safe in individuals with complete motor SCI. Moreover, to optimize the recruitment rate and safety in future trials, this study now highlights the need of developing pre-training rehabilitation programs to increase passive lower extremity range of motion and standing tolerance. This study also calls for the development of clinical practice guidelines targeting fragility fracture risk assessment linked to the use of overground robotic exoskeletons.

Combined training improves walking mobility in persons with significant disability from multiple sclerosis: a pilot study.

PubMed

Motl, Robert W; Smith, Douglas C; Elliott, Jeannette; Weikert, Madeline; Dlugonski, Deirdre; Sosnoff, Jacob J

2012-03-01

The disabling consequences of multiple sclerosis (MS) emphasize the significance of developing physiologically relevant strategies for rehabilitation of function. This pilot study examined changes in walking function associated with combined exercise training consisting of aerobic, resistance, and balance activities in persons with MS who had recent onset of gait impairment. Thirteen participants with significant disability due to MS (Expanded Disability Status Scale range = 4.0-6.0) completed the Multiple Sclerosis Walking Scale-12, 2 trials of the Timed 25-Foot Walk, the Timed Up & Go, and functional ambulation profile score derived from 4 walking trials on an instrumented walkway (GaitRite) before and after an 8-week training period. The training program was designed by a physical therapist and was performed 3 days per week under the supervision of an exercise specialist. In week 1, the session was 15 minutes in duration (ie, 5 minutes of each mode of exercise), session durations were increased by approximately 5 minutes per week up to a maximum of 60 minutes in week 8 (ie, 20 minutes of each mode of exercise). There were significant improvements in Multiple Sclerosis Walking Scale-12 scores (Mpre = 56.0, Mpost = 46.7, P = 0.03, d = 0.56), Timed 25-Foot Walk (Mpre = 11.7, Mpost = 9.8, P = 0.004, d = 0.90) and Timed Up & Go (Mpre = 16.0, Mpost = 13.0, P = 0.01, d = 0.72) performance, and functional ambulation profile score (Mpre = 72.8, Mpost = 77.6, P = 0.02, d = 0.65). These results suggest that a moderately intense, comprehensive, combined exercise training program represents a rehabilitation strategy that is associated with improved walking mobility in a small sample of persons with MS who have recent onset of gait impairment.

Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial.

PubMed

Yang, Yea-Ru; Tsai, Meng-Pin; Chuang, Tien-Yow; Sung, Wen-Hsu; Wang, Ray-Yau

2008-08-01

This is a single blind randomized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke. Twenty subjects with stroke were assigned randomly to either the control group (n=9) or the experimental group (n=11). Subjects in the control group received the treadmill training. Subjects in the experimental group underwent the virtual reality-based treadmill training. Walking speed, community walking time, walking ability questionnaire (WAQ), and activities-specific balance confidence (ABC) scale were evaluated. Subjects in the experimental group improved significantly in walking speed, community walking time, and WAQ score at posttraining and 1-month follow-up periods. Their ABC score also significantly increased at posttraining but did not maintain at follow-up period. Regarding the between-group comparisons, the experimental group improved significantly more than control group in walking speed (P=0.03) and community walking time (P=0.04) at posttraining period and in WAQ score (P=0.03) at follow-up period. Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke.

Industry Talks the Talk and Walks the Walk

ERIC Educational Resources Information Center

Lewis, C. Deanna

2008-01-01

Home Builders Institute (HBI), the workforce development arm of the National Association of Home Builders (NAHB), is dedicated to the advancement and enrichment of education and training programs serving the needs of the building industry. For more than 30 years, HBI has trained skilled workers in residential construction, promoted the industry as…

Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study

PubMed Central

2011-01-01

Background It is not yet established if the use of body weight support (BWS) systems for gait training is effective per se or if it is the combination of BWS and treadmill that improves the locomotion of individuals with gait impairment. This study investigated the effects of gait training on ground level with partial BWS in individuals with stroke during overground walking with no BWS. Methods Twelve individuals with chronic stroke (53.17 ± 7.52 years old) participated of a gait training program with BWS during overground walking, and were evaluated before and after the gait training period. In both evaluations, individuals were videotaped walking at a self-selected comfortable speed with no BWS. Measurements were obtained for mean walking speed, step length, stride length and speed, toe-clearance, durations of total double stance and single-limb support, and minimum and maximum foot, shank, thigh, and trunk segmental angles. Results After gait training, individuals walked faster, with symmetrical steps, longer and faster strides, and increased toe-clearance. Also, they displayed increased rotation of foot, shank, thigh, and trunk segmental angles on both sides of the body. However, the duration of single-limb support remained asymmetrical between each side of the body after gait training. Conclusions Gait training individuals with chronic stroke with BWS during overground walking improved walking in terms of temporal-spatial parameters and segmental angles. This training strategy might be adopted as a safe, specific and promising strategy for gait rehabilitation after stroke. PMID:21864373

Using robot-applied resistance to augment body-weight-supported treadmill training in an individual with incomplete spinal cord injury.

PubMed

Lam, Tania; Pauhl, Katherine; Krassioukov, Andrei; Eng, Janice J

2011-01-01

The efficacy of task-specific gait training for people with spinal cord injury (SCI) is premised on evidence that the provision of gait-related afferent feedback is key for the recovery of stepping movements. Recent findings have shown that sensory feedback from flexor muscle afferents can facilitate flexor muscle activity during the swing phase of walking. This case report was undertaken to determine the feasibility of using robot-applied forces to resist leg movements during body-weight-supported treadmill training (BWSTT) and to measure its effect on gait and other health-related outcomes. The patient described in this case report was a 43-year-old man with a T11 incomplete chronic SCI. He underwent 36 sessions of BWSTT using a robotic gait orthosis to provide forces that resist hip and knee flexion. Tolerance to the training program was monitored using the Borg CR10 scale and heart rate and blood pressure changes during each training session. Outcome measures (ie, 10-Meter Walk Test, Six-Minute Walk Test, modified Emory Functional Ambulation Profile [mEFAP], Activities-specific Balance Confidence Scale, and Canadian Occupational Performance Measure) were completed and kinematic parameters of gait, lower-extremity muscle strength (force-generating capacity), lower-limb girth, and tolerance to orthostatic stress were measured before and after the training program. The patient could tolerate the training. Overground walking speed, endurance, and performance on all subtasks of the mEFAP improved and were accompanied by increased lower-limb joint flexion and toe clearance during gait. The patient's ambulatory self-confidence and self-perceived performance in walking also improved. These findings suggest that this new approach to BWSTT is a feasible and potentially effective therapy for improving skilled overground walking performance.

Exercise training for intermittent claudication.

PubMed

McDermott, Mary M

2017-11-01

The objective of this study was to provide an overview of evidence regarding exercise therapies for patients with lower extremity peripheral artery disease (PAD). This manuscript summarizes the content of a lecture delivered as part of the 2016 Crawford Critical Issues Symposium. Multiple randomized clinical trials demonstrate that supervised treadmill exercise significantly improves treadmill walking performance in people with PAD and intermittent claudication symptoms. A meta-analysis of 25 randomized trials demonstrated a 180-meter increase in treadmill walking distance in response to supervised exercise interventions compared with a nonexercising control group. Supervised treadmill exercise has been inaccessible to many patients with PAD because of lack of medical insurance coverage. However, in 2017, the Centers for Medicare and Medicaid Services issued a decision memorandum to support health insurance coverage of 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. Recent evidence also supports home-based walking exercise to improve walking performance in people with PAD. Effective home-exercise programs incorporate behavioral change interventions such as a remote coach, goal setting, and self-monitoring. Supervised treadmill exercise programs preferentially improve treadmill walking performance, whereas home-based walking exercise programs preferentially improve corridor walking, such as the 6-minute walk test. Clinical trial evidence also supports arm or leg ergometry exercise to improve walking endurance in people with PAD. Treadmill walking exercise appears superior to resistance training alone for improving walking endurance. Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters compared with no exercise. Recent evidence suggests that home-based exercise is also effective and preferentially improves over-ground walking performance, such as the 6-minute walk test. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial.

PubMed

Nadeau, Stephen E; Wu, Samuel S; Dobkin, Bruce H; Azen, Stanley P; Rose, Dorian K; Tilson, Julie K; Cen, Steven Y; Duncan, Pamela W

2013-05-01

After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability. To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke. The locomotor experience applied post-stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (<0.4 m/s) or moderate (0.4 to <0.8 m/s). Between 2 and 6 months, they received either only UC (n = 143) or UC plus 36 therapist-provided sessions of either (1) walking training on a treadmill using body-weight support and practice overground at clinics (locomotor training program [LTP], n = 139) or (2) impairment-based strength and balance exercise at home (home exercise program [HEP], n = 126). LTP participants were 18% more likely to transition to a higher functional walking level: severe to >0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants. Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment.

Effects of ballates, step aerobics, and walking on balance in women aged 50-75 years.

PubMed

Clary, Sarah; Barnes, Cathleen; Bemben, Debra; Knehans, Allen; Bemben, Michael

2006-01-01

This study examined the effectiveness of Ballates training (strengthening of the central core musculature by the inception of balance techniques) compared to more traditional exercise programs, such as step aerobics and walking, on balance in women aged 50- 75 years. Participants were randomly assigned to one of three supervised training groups (1 hour/day, 3 days/week, 13 weeks), Ballates (n = 12), step aerobics (n = 17), or walking (n =15). Balance was measured by four different methods (modified Clinical Test for the Sensory Interaction on Balance - mCTSIB; Unilateral Stance with Eyes Open - US-EO or Eyes Closed - US-EC; Tandem Walk - TW; Step Quick Turn - SQT) using the NeuroCom Balance Master. A 2-way (Group and Trial) repeated measures ANOVA and post-hoc Bonferroni Pair-wise Comparisons were used to evaluate changes in the dependent variables used to describe stability and balance (sway velocity, turn sway, speed, and turn time). Measures of static postural stability and dynamic balance were similar for the three groups prior to training. Following the different exercise interventions, sway velocity on firm and foam surfaces (mCTSIB) with eyes closed (p < 0.05) increased for the Ballates group while the other two exercise groups either maintained or decreased their sway velocity following the training, therefore suggesting that these two groups either maintained or improved their balance. There were significant improvements in speed during the TW test (p < 0.01), and turn time (p < 0.01) and sway (p < 0.05) during the SQT test for each of the three groups. In general, all three training programs improved dynamic balance, however, step aerobics and walking programs resulted in be better improvements in postural stability or static balance when compared to the Ballates program. Key PointsExercise training can improve balanceNeed to consider both static and dynamic aspects of balance individuallyImproved balance can reduce the risk of fall.

Effects of training and weight support on muscle activation in Parkinson's disease.

PubMed

Rose, Martin H; Løkkegaard, Annemette; Sonne-Holm, Stig; Jensen, Bente R

2013-12-01

The aim of this study was to investigate the effect of high-intensity locomotor training on knee extensor and flexor muscle activation and adaptability to increased body-weight (BW) support during walking in patients with Parkinson's disease (PD). Thirteen male patients with idiopathic PD and eight healthy participants were included. The PD patients completed an 8-week training program on a lower-body, positive-pressure treadmill. Knee extensor and flexor muscles activation during steady treadmill walking (3 km/h) were measured before, at the mid-point, and after training. Increasing BW support decreased knee extensor muscle activation (normalization) and increased knee flexor muscle activation (abnormal) in PD patients when compared to healthy participants. Training improved flexor peak muscle activation adaptability to increased (BW) support during walking in PD patients. During walking without BW support shorter knee extensor muscle off-activation time and increased relative peak muscle activation was observed in PD patients and did not improve with 8 weeks of training. In conclusion, patients with PD walked with excessive activation of the knee extensor and flexor muscles when compared to healthy participants. Specialized locomotor training may facilitate adaptive processes related to motor control of walking in PD patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Nordic walking versus walking without poles for rehabilitation with cardiovascular disease: Randomized controlled trial.

PubMed

Girold, Sébastien; Rousseau, Jérome; Le Gal, Magalie; Coudeyre, Emmanuel; Le Henaff, Jacqueline

2017-07-01

With Nordic walking, or walking with poles, one can travel a greater distance and at a higher rate than with walking without poles, but whether the activity is beneficial for patients with cardiovascular disease is unknown. This randomized controlled trial was undertaken to determine whether Nordic walking was more effective than walking without poles on walk distance to support rehabilitation training for patients with acute coronary syndrome (ACS) and peripheral arterial occlusive disease (PAOD). Patients were recruited in a private specialized rehabilitation centre for cardiovascular diseases. The entire protocol, including patient recruitment, took place over 2 months, from September to October 2013. We divided patients into 2 groups: Nordic Walking Group (NWG, n=21) and Walking Group without poles (WG, n=21). All patients followed the same program over 4 weeks, except for the walk performed with or without poles. The main outcome was walk distance on the 6-min walk test. Secondary outcomes were maximum heart rate during exercise and walk distance and power output on a treadmill stress test. We included 42 patients (35 men; mean age 57.2±11 years and BMI 26.5±4.5kg/m 2 ). At the end of the training period, both groups showed improved walk distance on the 6-min walk test and treatment stress test as well as power on the treadmill stress test (P<0.05). The NWG showed significantly greater walk distance than the WG (P<0.05). Both ACS and PAOD groups showed improvement, but improvement was significant for only PAOD patients. After a 4-week training period, Nordic walking training appeared more efficient than training without poles for increasing walk distance on the 6-min walk test for patients with ACS and PAOD. Copyright © 2017. Published by Elsevier Masson SAS.

Community walking programs for treatment of peripheral artery disease

PubMed Central

Mays, Ryan J.; Rogers, R. Kevin; Hiatt, William R.; Regensteiner, Judith G.

2013-01-01

Background Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), while effective, are often not utilized due to barriers including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option, as they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methodologies and outcomes of community walking programs for PAD. Methods A literature review using appropriate search terms was conducted within PubMed/Medline and the Cochrane databases to identify studies in the English language employing community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. Results Randomized controlled trials (n=10) examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes with no differences in peak walking time compared to supervised walking exercise groups. Conclusions Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs. PMID:24103409

A task-oriented circuit training in multiple sclerosis: a feasibility study

PubMed Central

2014-01-01

Background The aim of this study was to evaluate the safety, feasibility and preliminary effects of a high-intensity rehabilitative task-oriented circuit training (TOCT) in a sample of multiple sclerosis (MS) subjects on walking competency, mobility, fatigue and health-related quality of life (HRQoL). Methods 24 MS subjects (EDSS 4.89 ± 0.54, 17 female and 7 male, 52.58 ± 11.21 years, MS duration 15.21 ± 8.68 years) have been enrolled and randomly assigned to 2 treatment groups: (i) experimental group received 10 TOCT sessions over 2 weeks (2 hours/each session) followed by a 3 months home exercise program, whereas control group did not receive any specific rehabilitation intervention. A feasibility patient-reported questionnaire was administered after TOCT. Functional outcome measures were: walking endurance (Six Minute Walk Test), gait speed (10 Meter Walk Test), mobility (Timed Up and Go test) and balance (Dynamic Gait Index). Furthermore, self-reported questionnaire of motor fatigue (Fatigue Severity Scale), walking ability (Multiple Sclerosis Walking Scale – 12) and health-related quality of life (Multiple Sclerosis Impact Scale – 29) were included. Subjects’ assessments were delivered at baseline (T0), after TOCT (T1) and 3 months of home-based exercise program (T2). Results After TOCT subjects reported a positive global rating on the received treatment. At 3 months, we found a 58.33% of adherence to the home-exercise program. After TOCT, walking ability and health-related quality of life were improved (p < 0.05) with minor retention after 3 months. The control group showed no significant changes in any variables. Conclusions This two weeks high-intensity task-oriented circuit class training followed by a three months home-based exercise program seems feasible and safe in MS people with moderate mobility impairments; moreover it might improve walking abilities. Trial registration NCT01464749 PMID:24906545

A Clinical Framework for Functional Recovery in a Person With Chronic Traumatic Brain Injury: A Case Study.

PubMed

McCain, Karen; Shearin, Staci

2017-07-01

This case study describes a task-specific training program for gait walking and functional recovery in a young man with severe chronic traumatic brain injury. The individual was a 26-year-old man 4 years post-traumatic brain injury with severe motor impairments who had not walked outside of therapy since his injury. He had received extensive gait training prior to initiation of services. His goal was to recover the ability to walk. The primary focus of the interventions was the restoration of walking. A variety of interventions were used, including locomotor treadmill training, electrical stimulation, orthoses, and specialized assistive devices. A total of 79 treatments were delivered over a period of 62 weeks. At the conclusion of therapy, the client was able to walk independently with a gait trainer for approximately 1km (over 3000 ft) and walked in the community with the assistance of his mother using a rocker bottom crutch for distances of 100m (330 ft). Specific interventions were intentionally selected in the development of the treatment plan. The program emphasized structured practice of the salient task, that is, walking, with adequate intensity and frequency. Given the chronicity of this individual's injury, the magnitude of his functional improvements was unexpected.Video Abstract available for additional insights from the Authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A175).

Training to walk amid uncertainty with Re-Step: measurements and changes with perturbation training for hemiparesis and cerebral palsy.

PubMed

Bar-Haim, Simona; Harries, Netta; Hutzler, Yeshayahu; Belokopytov, Mark; Dobrov, Igor

2013-09-01

To describe Re-Step™, a novel mechatronic shoe system that measures center of pressure (COP) gait parameters and complexity of COP dispersion while walking, and to demonstrate these measurements in healthy controls and individuals with hemiparesis and cerebral palsy (CP) before and after perturbation training. The Re-Step™ was used to induce programmed chaotic perturbations to the feet while walking for 30 min for 36 sessions over 12-weeks of training in two subjects with hemiparesis and two with CP. Baseline measurements of complexity indices (fractal dimension and approximate entropy) tended to be higher in controls than in those with disabilities, while COP variability, mean and variability of step time and COP dispersion were lower. After training the disabled subjects these measurement values tended toward those of the controls, along with a decrease in step time, 10 m walk time, average step time, percentage of double support and increased Berg balance score. This pilot trial reveals the feasibility and applicability of this unique measurement and perturbation system for evaluating functional disabilities and changes with interventions to improve walking. Implication for Rehabilitation Walking, of individuals with cerebral palsy and hemiparesis following stroke, can be viewed in terms of a rigid motor behavior that prevents adaptation to changing environmental conditions. Re-Step system (a) measures and records linear and non-linear gait parameters during free walking to provide a detailed evaluation of walking disabilities, (b) is an intervention training modality that applies unexpected perturbations during walking. This perturbation intervention may improve gait and motor functions of individuals with hemiparesis and cerebral plasy.

A 3-Month Aerobic Training Program Improves Brain Energy Metabolism in Mild Alzheimer's Disease: Preliminary Results from a Neuroimaging Study.

PubMed

Castellano, Christian-Alexandre; Paquet, Nancy; Dionne, Isabelle J; Imbeault, Hélène; Langlois, Francis; Croteau, Etienne; Tremblay, Sébastien; Fortier, Mélanie; Matte, J Jacques; Lacombe, Guy; Fülöp, Tamás; Bocti, Christian; Cunnane, Stephen C

2017-01-01

Aerobic training has some benefits for delaying the onset or progression of Alzheimer's disease (AD). Little is known about the implication of the brain's two main fuels, glucose and ketones (acetoacetate), associated with thesebenefits. To determine whether aerobic exercise training modifies brain energy metabolism in mild AD. In this uncontrolled study, ten patients with mild AD participated in a 3-month, individualized, moderate-intensity aerobic training on a treadmill (Walking). Quantitative measurement of brain uptake of glucose (CMRglu) and acetoacetate (CMRacac) using neuroimaging and cognitive testing were done before and after the Walking program. Four men and six women with an average global cognitive score (MMSE) of 26/30 and an average age of 73 y completed the Walking program. Average total distance and treadmill speed were 8 km/week and 4 km/h, respectively. Compared to the Baseline, after Walking, CMRacac was three-fold higher (0.6±0.4 versus 0.2±0.1 μmol/100 g/min; p = 0.01). Plasma acetoacetate concentration and the blood-to-brain acetoacetate influx rate constant were also increased by 2-3-fold (all p≤0.03). CMRglu was unchanged after Walking (28.0±0.1 μmol/100 g/min; p = 0.96). There was a tendency toward improvement in the Stroop-color naming test (-10% completion time, p = 0.06). Performance on the Trail Making A&B tests was also directly related to plasma acetoacetate and CMRacac (all p≤0.01). In mild AD, aerobic training improved brain energy metabolism by increasing ketone uptake and utilization while maintaining brain glucose uptake, and could potentially be associated with some cognitive improvement.

Effects of curved-walking training on curved-walking performance and freezing of gait in individuals with Parkinson's disease: A randomized controlled trial.

PubMed

Cheng, Fang-Yu; Yang, Yea-Ru; Wu, Yih-Ru; Cheng, Shih-Jung; Wang, Ray-Yau

2017-10-01

The purpose of this study was to investigate the effects of curved-walking training (CWT) on curved-walking performance and freezing of gait (FOG) in people with Parkinson's disease (PD). Twenty-four PD subjects were recruited and randomly assigned to the CWT group or control exercise (CE) group and received 12 sessions of either CWT with a turning-based treadmill or general exercise training for 30 min followed by 10 min of over-ground walking in each session for 4-6 weeks. The primary outcomes included curved-walking performance and FOG. All measurements were assessed at baseline, after training, and at 1-month follow-up. Our results showed significant improvements in curved-walking performance (speed, p = 0.007; cadence, p = 0.003; step length, p < 0.001) and FOG, measured by a FOG questionnaire (p = 0.004). The secondary outcomes including straight-walking performance (speed, cadence and step length, p < 0.001), timed up and go test (p = 0.014), functional gait assessment (p < 0.001), Unified Parkinson's disease Rating Scale III (p = 0.001), and quality of life (p < 0.001) were also improved in the experimental group. We further noted that the improvements were maintained for at least one month after training (p < 0.05). A 12-session CWT program can improve curved-walking ability, FOG, and other measures of functional walking performance in individuals with PD. Most of the improvements were sustained for at least one month after training. Copyright © 2017 Elsevier Ltd. All rights reserved.

Walking training and cortisol to DHEA-S ratio in postmenopause: An intervention study.

PubMed

Di Blasio, Andrea; Izzicupo, Pascal; Di Baldassarre, Angela; Gallina, Sabina; Bucci, Ines; Giuliani, Cesidio; Di Santo, Serena; Di Iorio, Angelo; Ripari, Patrizio; Napolitano, Giorgio

2018-04-01

The literature indicates that the plasma cortisol-to-dehydroepiandrosterone-sulfate (DHEA-S) ratio is a marker of health status after menopause, when a decline in both estrogen and DHEA-S and an increase in cortisol occur. An increase in the cortisol-to-DHEA-S ratio has been positively correlated with metabolic syndrome, all-cause mortality, cancer, and other diseases. The aim of this study was to investigate the effects of a walking program on the plasma cortisol-to-DHEA-S ratio in postmenopausal women. Fifty-one postmenopausal women participated in a 13-week supervised walking program, in the metropolitan area of Pescara (Italy), from June to September 2013. Participants were evaluated in April-May and September-October of the same year. The linear mixed model showed that the variation of the log 10 Cortisol-to-log 10 DHEA-S ratio was associated with the volume of exercise (p = .03). Participants having lower adherence to the walking program did not have a significantly modified log 10 Cortisol or log 10 DHEA-S, while those having the highest adherence had a significant reduction in log 10 Cortisol (p = .016) and a nearly significant increase in log 10 DHEA-S (p = .084). Walking training appeared to reduce the plasma log 10 Cortisol-to-log 10 DHEA-S ratio, although a minimum level of training was necessary to achieve this significant reduction.

Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis.

PubMed

Snook, Erin M; Motl, Robert W

2009-02-01

The study used meta-analytic procedures to examine the overall effect of exercise training interventions on walking mobility among individuals with multiple sclerosis. A search was conducted for published exercise training studies from 1960 to November 2007 using MEDLINE, PsychINFO, CINAHL, and Current Contents Plus. Studies were selected if they measured walking mobility, using instruments identified as acceptable walking mobility constructs and outcome measures for individuals with neurologic disorders, before and after an intervention that included exercise training. Forty-two published articles were located and reviewed, and 22 provided enough data to compute effect sizes expressed as Cohen's d. Sixty-six effect sizes were retrieved from the 22 publications with 600 multiple sclerosis participants and yielded a weighted mean effect size of g = 0.19 (95% confidence interval, 0.09-0.28). There were larger effects associated with supervised exercise training ( g = 0.32), exercise programs that were less than 3 months in duration (g = 0.28), and mixed samples of relapsing-remitting and progressive multiple sclerosis (g = 0.52). The cumulative evidence supports that exercise training is associated with a small improvement in walking mobility among individuals with multiple sclerosis.

Body-weight-supported treadmill rehabilitation after stroke.

PubMed

Duncan, Pamela W; Sullivan, Katherine J; Behrman, Andrea L; Azen, Stanley P; Wu, Samuel S; Nadeau, Stephen E; Dobkin, Bruce H; Rose, Dorian K; Tilson, Julie K; Cen, Steven; Hayden, Sarah K

2011-05-26

Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established. We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment--moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second)--and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke. At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P=0.02). Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.).

The effects of Nordic Walking training on selected upper-body muscle groups in female-office workers: A randomized trial.

PubMed

Kocur, Piotr; Pospieszna, Barbara; Choszczewski, Daniel; Michalowski, Lukasz; Wiernicka, Marzena; Lewandowski, Jacek

2017-01-01

Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial

PubMed Central

Alexeeva, Natalia; Sames, Carol; Jacobs, Patrick L.; Hobday, Lori; DiStasio, Marcello M.; Mitchell, Sarah A.; Calancie, Blair

2011-01-01

Objective To compare two forms of device-specific training – body-weight-supported (BWS) ambulation on a fixed track (TRK) and BWS ambulation on a treadmill (TM) – to comprehensive physical therapy (PT) for improving walking speed in persons with chronic, motor-incomplete spinal cord injury (SCI). Methods Thirty-five adult subjects with a history of chronic SCI (>1 year; AIS ‘C’ or ‘D’) participated in a 13-week (1 hour/day; 3 days per week) training program. Subjects were randomized into one of the three training groups. Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert. For each training session, performance values and heart rate were monitored. Pre- and post-training maximal 10-m walking speed, balance, muscle strength, fitness, and quality of life were assessed in each subject. Results All three training groups showed significant improvement in maximal walking speed, muscle strength, and psychological well-being. A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group. In all groups, post-training measures of fitness, functional independence, and perceived health and vitality were unchanged. Conclusions Our results demonstrate that persons with chronic, motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy, regardless of training method. Improvement in walking speed was associated with improved balance and muscle strength. In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups, these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength. It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training. PMID:21903010

Lower extremity robotic exoskeleton training: Case studies for complete spinal cord injury walking.

PubMed

Lemaire, Edward D; Smith, Andrew J; Herbert-Copley, Andrew; Sreenivasan, Vidya

2017-01-01

Recent advances in exoskeleton technology has made lower extremity powered exoskeletons (LEPE) a viable treatment tool to restore upright walking mobility to persons with spinal cord injury (SCI). Evaluate ARKE exoskeleton training within a rehabilitation centre environment. Case studies are presented for two male participants, age 41 and 30, motor complete SCI at T6 (N01) and T12 (N02), respectively, as they progress from new LEPE users to independent walking. The ARKE 2.0 LEPE (Bionik Laboratories Inc., Toronto, Canada) was used for all training (hip and knee powered, forearm crutches, control tablet). Data were collected on session times, activity metrics from ARKE system logs, and qualitative questionnaire feedback. N01 required 18, 30-minute training sessions to achieve independent walking. N01 walked independently within the 12 session target. Foot strikes were frequently before the end of the programmed swing phase, which were handled by the ARKE control system. Subjective ratings of LEPE learning, comfort, pain, fatigue, and overall experience were high for sitting-standing and moderate to high for walking. This reflected the complexity of learning to safely walk. Qualitative feedback supported the continuation of LEPE use in rehabilitation settings based on end-user desire for upright mobility.

Seasonal influence on adherence to and effects of an interval walking training program on sedentary female college students in Japan

NASA Astrophysics Data System (ADS)

Tanabe, Aiko; Masuki, Shizue; Nemoto, Ken-ichi; Nose, Hiroshi

2017-11-01

Habitual exercise training is recommended to young people for their health promotion, but adherence may be influenced by atmospheric temperature (T a ) if performed outdoors. We compared the adherence to and the effects of a home-based interval walking training (IWT) program on sedentary female college students between winter and summer. For summer training over 176 days, 48 subjects (18-22 years old) were randomly divided into two groups: the control group (CNTsummer, n = 24), which maintained a sedentary lifestyle as before, and the IWT group (IWTsummer, n = 24), which performed IWT while energy expenditure was monitored by accelerometry. For winter training over 133 days, another group of 47 subjects (18-24 years old) was randomly divided into CNTwinter (n = 24) and IWTwinter (n = 23), as in summer. The peak T a per day was 26 ± 6 °C (SD) (range of 9-35 °C) in summer, much higher than 7 ± 5 °C (range of - 3-20 °C) in winter (P < 0.001). During a 50-day vacation period, participants walked 2.1 ± 0.3 (SE) days/week in IWTsummer, less than 4.2 ± 0.3 days/week in IWTwinter (P < 0.001), with half of the energy expenditure/week for fast walking during the winter vacation (P < 0.02), whereas both IWT groups walked 2 days/week during a school period (P > 0.8). After training, the peak aerobic capacity and knee flexion force increased in IWTwinter (P < 0.01) but not in CNTwinter (P > 0.3). Conversely, these parameters decreased in the summer groups. Thus, the adherence to and effects of IWT on sedentary female college students in Japan decreased in summer at least partially due to a high T a .

Effect of body-weight suspension training versus treadmill training on gross motor abilities of children with spastic diplegic cerebral palsy.

PubMed

Emara, Hatem A; El-Gohary, Tarek M; Al-Johany, Ahmed A

2016-06-01

Suspension training and treadmill training are commonly used for promoting functional gross motor skills in children with cerebral palsy. The aim of this study was to compare the effect of body-weight suspension training versus treadmill training on gross motor functional skills. Assessor-blinded, randomized, controlled intervention study. Outpatient rehabilitation facility. Twenty children with spastic diplegia (7 boys and 13 girls) in the age ranged from 6 to 8 years old were randomly allocated into two equal groups. All children were assessed at baseline, after 18-session and after 36-session. During the twelve-week outpatient rehabilitation program, both groups received traditional therapeutic exercises. Additionally, one group received locomotor training using the treadmill while the other group received locomotor training using body-weight suspension through the dynamic spider cage. Assessment included dimensions "D" standing and "E" walking of the gross motor function measure, in addition to the 10-m Walking Test and the five times sit to stand test. Training was applied three times per week for twelve consecutive weeks. No significant difference was found in standing or walking ability for measurements taken at baseline or after 18-session of therapy. Measurements taken at 36-session showed that suspension training achieved significantly (P<0.05) higher average score than treadmill training for dimension D as well as for dimension E. No significant difference was found between suspension training and treadmill training regarding walking speed or sit to stand transitional skills. Body-weight suspension training is effective in improving walking and locomotor capabilities in children with spastic diplegia. After three month suspension training was superior to treadmill training. Body-weight suspension training promotes adequate postural stability, good balance control, and less exertion which facilitates efficient and safe gait.

Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis.

PubMed

Miller, Larry E; Zimmermann, Angela K; Herbert, William G

2016-01-01

Powered exoskeletons are designed to safely facilitate ambulation in patients with spinal cord injury (SCI). We conducted the first meta-analysis of the available published research on the clinical effectiveness and safety of powered exoskeletons in SCI patients. MEDLINE and EMBASE databases were searched for studies of powered exoskeleton-assisted walking in patients with SCI. Main outcomes were analyzed using fixed and random effects meta-analysis models. A total of 14 studies (eight ReWalk™, three Ekso™, two Indego(®), and one unspecified exoskeleton) representing 111 patients were included in the analysis. Training programs were typically conducted three times per week, 60-120 minutes per session, for 1-24 weeks. Ten studies utilized flat indoor surfaces for training and four studies incorporated complex training, including walking outdoors, navigating obstacles, climbing and descending stairs, and performing activities of daily living. Following the exoskeleton training program, 76% of patients were able to ambulate with no physical assistance. The weighted mean distance for the 6-minute walk test was 98 m. The physiologic demand of powered exoskeleton-assisted walking was 3.3 metabolic equivalents and rating of perceived exertion was 10 on the Borg 6-20 scale, comparable to self-reported exertion of an able-bodied person walking at 3 miles per hour. Improvements in spasticity and bowel movement regularity were reported in 38% and 61% of patients, respectively. No serious adverse events occurred. The incidence of fall at any time during training was 4.4%, all occurring while tethered using a first-generation exoskeleton and none resulting in injury. The incidence of bone fracture during training was 3.4%. These risks have since been mitigated with newer generation exoskeletons and refinements to patient eligibility criteria. Powered exoskeletons allow patients with SCI to safely ambulate in real-world settings at a physical activity intensity conducive to prolonged use and known to yield health benefits.

Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis

PubMed Central

Miller, Larry E; Zimmermann, Angela K; Herbert, William G

2016-01-01

Background Powered exoskeletons are designed to safely facilitate ambulation in patients with spinal cord injury (SCI). We conducted the first meta-analysis of the available published research on the clinical effectiveness and safety of powered exoskeletons in SCI patients. Methods MEDLINE and EMBASE databases were searched for studies of powered exoskeleton-assisted walking in patients with SCI. Main outcomes were analyzed using fixed and random effects meta-analysis models. Results A total of 14 studies (eight ReWalk™, three Ekso™, two Indego®, and one unspecified exoskeleton) representing 111 patients were included in the analysis. Training programs were typically conducted three times per week, 60–120 minutes per session, for 1–24 weeks. Ten studies utilized flat indoor surfaces for training and four studies incorporated complex training, including walking outdoors, navigating obstacles, climbing and descending stairs, and performing activities of daily living. Following the exoskeleton training program, 76% of patients were able to ambulate with no physical assistance. The weighted mean distance for the 6-minute walk test was 98 m. The physiologic demand of powered exoskeleton-assisted walking was 3.3 metabolic equivalents and rating of perceived exertion was 10 on the Borg 6–20 scale, comparable to self-reported exertion of an able-bodied person walking at 3 miles per hour. Improvements in spasticity and bowel movement regularity were reported in 38% and 61% of patients, respectively. No serious adverse events occurred. The incidence of fall at any time during training was 4.4%, all occurring while tethered using a first-generation exoskeleton and none resulting in injury. The incidence of bone fracture during training was 3.4%. These risks have since been mitigated with newer generation exoskeletons and refinements to patient eligibility criteria. Conclusion Powered exoskeletons allow patients with SCI to safely ambulate in real-world settings at a physical activity intensity conducive to prolonged use and known to yield health benefits. PMID:27042146

Compliance of children with moderate to severe intellectual disability to treadmill walking: a pilot study.

PubMed

Vashdi, E; Hutzler, Y; Roth, D

2008-05-01

Individuals with Intellectual Disability (ID) exhibit reduced levels of compliance to exercise, including treadmill walking. The purpose of this study was to measure the effects of several training conditions on compliance to participation in treadmill walking of children with moderate to severe ID. Criteria for compliance were the averaged number of times participants attempted to discontinue walking during two 5-min exercise sessions of treadmill walking at an intensity of 65-75% of predicted maximal HR. Fifteen children aged 5-11 with moderate to severe ID participated in the study. Training conditions were (a) close supervisor's position, (b) distant supervisor's position, (c) positive reinforcement, and (d) paired modeling. General linear mixed model statistics revealed significant differences in favor of the paired modeling and positive reinforcement compared to the other conditions. Leaning forward was the most frequent type of participants' attempt to stop exercising. Paired modeling and positive reinforcement should be considered within treadmill training programs for children with moderate to severe ID.

Effects of Combined Aerobic-Strength Training vs Fitness Education Program in COPD Patients.

PubMed

Rinaldo, Nicoletta; Bacchi, Elisabetta; Coratella, Giuseppe; Vitali, Francesca; Milanese, Chiara; Rossi, Andrea; Schena, Federico; Lanza, Massimo

2017-11-01

We compared the effects of a new physical activity education program approach (EDU), based on a periodically supervised protocol of different exercise modalities vs traditionally supervised combined strength-endurance training (CT) on health-related factors in patients with stable chronic obstructive pulmonary disease (COPD). Twenty-eight COPD patients without comorbidities were randomly assigned to receive either EDU or CT. CT was continuously supervised to combine strength-endurance training; EDU was taught to progressively increase the rate of autonomous physical activity, through different training modalities such as Nordic walking, group classes and circuit training. Body composition, walking capacity, muscle strength, flexibility and balance, total daily energy expenditure and quality of life were evaluated at baseline, after 28 weeks training period (3d/week) and after a 14-week follow-up. No adverse events occurred during the interventions. After training, CT and EDU similarly improved walking capacity, body composition and quality of life. However, after 14 weeks of follow-up, such improvements were not maintained. Only in CT, muscle strength and flexibility improved after training but returned to baseline after follow-up. EDU, similar to CT, can effectively and safely improve health-related parameters in COPD patients. EDU could be an attractive alternative to traditional supervised training for improving quality of life in COPD patients. © Georg Thieme Verlag KG Stuttgart · New York.

Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients.

PubMed

Cho, Ki Hun; Kim, Min Kyu; Lee, Hwang-Jae; Lee, Wan Hee

2015-08-01

Virtual reality training is considered as an effective intervention method of stroke patients, and the virtual reality system for therapeutic rehabilitation has emphasized the cognitive factors to improve walking function. The purpose of current study was to investigate the effect of virtual reality training with cognitive load (VRTCL) on walking function of chronic stroke. Chronic stroke patients were randomly assigned to the VRTCL group (11 patients, including 5 men; mean age, 60.0 years; post-stroke duration, 273.9 days) or control group (11 patients, including 2 men; mean age, 58.6 years; post-stroke duration, 263.9 days). All subjects participated in the standard rehabilitation program that consisted of physical and occupational therapies. In addition, VRTCL group participated in the VRTCL for 4 weeks (30 min per day and five times a week), while those in the control group participated in virtual reality treadmill training. Walking function under single (walking alone) and dual task (walking with cognitive tasks) conditions was assessed using an electrical walkway system. After the 4-week intervention, under both single and dual task conditions, significant improvement on walking function was observed in VRTCL and control groups (P < 0.05). In addition, in the dual task condition, greater improvement on walking function was observed in the VRTCL group, compared with the control group (P < 0.05). These findings demonstrated the efficacy of VRTCL on the walking function under the dual task condition. Therefore, we suggest that VRTCL may be an effective method for the achievement of independent walking in chronic stroke patients.

Robot-assisted gait training in patients with Parkinson disease: a randomized controlled trial.

PubMed

Picelli, Alessandro; Melotti, Camilla; Origano, Francesca; Waldner, Andreas; Fiaschi, Antonio; Santilli, Valter; Smania, Nicola

2012-05-01

. Gait impairment is a common cause of disability in Parkinson disease (PD). Electromechanical devices to assist stepping have been suggested as a potential intervention. . To evaluate whether a rehabilitation program of robot-assisted gait training (RAGT) is more effective than conventional physiotherapy to improve walking. . A total of 41 patients with PD were randomly assigned to 45-minute treatment sessions (12 in all), 3 days a week, for 4 consecutive weeks of either robotic stepper training (RST; n = 21) using the Gait Trainer or physiotherapy (PT; n = 20) with active joint mobilization and a modest amount of conventional gait training. Participants were evaluated before, immediately after, and 1 month after treatment. Primary outcomes were 10-m walking speed and distance walked in 6 minutes. . Baseline measures revealed no statistical differences between groups, but the PT group walked 0.12 m/s slower; 5 patients withdrew. A statistically significant improvement was found in favor of the RST group (walking speed 1.22 ± 0.19 m/s [P = .035]; distance 366.06 ± 78.54 m [P < .001]) compared with the PT group (0.98 ± 0.32 m/s; 280.11 ± 106.61 m). The RAGT mean speed increased by 0.13 m/s, which is probably not clinically important. Improvements were maintained 1 month later. . RAGT may improve aspects of walking ability in patients with PD. Future trials should compare robotic assistive training with treadmill or equal amounts of overground walking practice.

Unexpected perturbations training improves balance control and voluntary stepping times in older adults - a double blind randomized control trial.

PubMed

Kurz, Ilan; Gimmon, Yoav; Shapiro, Amir; Debi, Ronen; Snir, Yoram; Melzer, Itshak

2016-03-04

Falls are common among elderly, most of them occur while slipping or tripping during walking. We aimed to explore whether a training program that incorporates unexpected loss of balance during walking able to improve risk factors for falls. In a double-blind randomized controlled trial 53 community dwelling older adults (age 80.1±5.6 years), were recruited and randomly allocated to an intervention group (n = 27) or a control group (n = 26). The intervention group received 24 training sessions over 3 months that included unexpected perturbation of balance exercises during treadmill walking. The control group performed treadmill walking with no perturbations. The primary outcome measures were the voluntary step execution times, traditional postural sway parameters and Stabilogram-Diffusion Analysis. The secondary outcome measures were the fall efficacy Scale (FES), self-reported late life function (LLFDI), and Performance-Oriented Mobility Assessment (POMA). Compared to control, participation in intervention program that includes unexpected loss of balance during walking led to faster Voluntary Step Execution Times under single (p = 0.002; effect size [ES] =0.75) and dual task (p = 0.003; [ES] = 0.89) conditions; intervention group subjects showed improvement in Short-term Effective diffusion coefficients in the mediolateral direction of the Stabilogram-Diffusion Analysis under eyes closed conditions (p = 0.012, [ES] = 0.92). Compared to control there were no significant changes in FES, LLFDI, and POMA. An intervention program that includes unexpected loss of balance during walking can improve voluntary stepping times and balance control, both previously reported as risk factors for falls. This however, did not transferred to a change self-reported function and FES. ClinicalTrials.gov NCT01439451 .

Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery.

PubMed

Heiberg, Kristi Elisabeth; Bruun-Olsen, Vigdis; Ekeland, Arne; Mengshoel, Anne Marit

2012-03-01

To investigate the effect of a 12-session walking skill training program of weight-bearing activities on physical functioning and self-efficacy initiated in patients 3 months after total hip arthroplasty (THA). Sixty-eight patients with THA, 35 women and 33 men, with a mean age of 66 years (95% confidence interval [95% CI] 64, 67 years), were randomized to a training group (n = 35) or a control group without physiotherapy (n = 33). Assessments were performed before the intervention at 3 months (pretest), at 5 months (posttest 1), and at 12 months (posttest 2) after surgery. The primary outcome was the 6-minute walk test (6MWT). The secondary outcomes were the stair climbing test (ST); figure-of-eight test; Index of Muscle Function (IMF); active hip range of motion (ROM) in flexion, extension, and abduction; Harris Hip Score (HHS); self-efficacy; and Hip Dysfunction and Osteoarthritis Outcome Score. The training group had larger improvements than the control group at posttest 1 on the 6MWT with an adjusted mean difference of 52 meters (95% CI 29, 74 meters; P < 0.001) and on the ST of -1 second (95% CI -2, 0 seconds; P = 0.01).There were also improvements on the figure-of-eight test (P = 0.02), IMF (P = 0.001), active hip ROM in extension (P = 0.02), HHS (P = 0.05), and self-efficacy (P = 0.04). The difference between the groups persisted at posttest 2 on the 6MWT of 52 meters (95% CI 24, 80 meters; P < 0.001) and on the ST of -1 second (95% CI -3, 0 seconds; P = 0.05). The walking skill training program was effective, especially in improving walking both immediately after the intervention and 1 year after THA surgery. Copyright © 2012 by the American College of Rheumatology.

Mobile-phone-based home exercise training program decreases systemic inflammation in COPD: a pilot study.

PubMed

Wang, Chun-Hua; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Ho, Shu-Chuan; Lin, Horng-Chyuan; Huang, Chien-Da; Chung, Fu-Tsai; Chung, Kian Fan; Kuo, Han-Pin

2014-08-30

Moderate-intensity exercise training improves skeletal muscle aerobic capacity and increased oxidative enzyme activity, as well as exercise tolerance in COPD patients. To investigate whether the home-based exercise training program can reduce inflammatory biomarkers in patients with COPD, twelve patients using mobile phone assistance and 14 with free walk were assessed by incremental shuttle walk test (ISWT), spirometry, strength of limb muscles, and serum C-reactive protein (CRP) and inflammatory cytokines. Patients in the mobile phone group improved their ISWT walking distance, with decrease in serum CRP after 2 months, and sustained at 6 months. Patients in the control group had no improvement. Serum IL-8 in the mobile phone group was significantly reduced at 2, 3 and 6 months after doing home exercise training compared to baseline. IL-6 and TNF-α were significantly elevated at 3 and 6 months in control group, while there were no changes in mobile phone group. The strength of limb muscles was significantly greater compared to baseline at 3 and 6 months in the mobile phone group. A mobile-phone-based system can provide an efficient home endurance exercise training program with improved exercise capacity, strength of limb muscles and a decrease in serum CRP and IL-8 in COPD patients. Decreased systemic inflammation may contribute to these clinical benefits. (Clinical trial registration No.: NCT01631019).

Effect of forced use of the lower extremity on gait performance and mobility of post-acute stroke patients

PubMed Central

Yu, Wen-Hsiu; Liu, Wen-Yu; Wong, Alice May-Kuen; Wang, Tzu-Chi; Li, Yen-Chen; Lien, Hen-Yu

2015-01-01

[Purpose] The purpose of this study was to investigate the effects of a forced-use training program on gait, mobility and quality of life of post-acute stroke patients. [Subjects] Twenty-one individuals with unilateral stroke participated in this study. All participants had suffered from first-ever stroke with time since onset of at least 3 months. [Methods] A single-blinded, non-equivalent, pre-post controlled design with 1-month follow-up was adopted. Participants received either a forced-use or a conventional physical therapy program for 2 weeks. The main outcomes assessed were preferred and fastest walking velocities, spatial and temporal symmetry indexes of gait, the timed up and go test, the Rivermead Mobility Index, and the Stroke-Specific Quality of Life Scale (Taiwan version). [Results] Forced-use training induced greater improvements in gait and mobility than conventional physical therapy. In addition, compared to pre-training, patients in the conventional physical therapy group walked faster but more asymmetrically after training. However, neither program effectively improved in-hospital quality of life. [Conclusion] The forced-use approach can be successfully applied to the lower extremities of stroke patients to improve mobility, walking speeds and symmetry of gait. PMID:25729182

Improved clinical status, quality of life, and walking capacity in Parkinson's disease after body weight-supported high-intensity locomotor training.

PubMed

Rose, Martin H; Løkkegaard, Annemette; Sonne-Holm, Stig; Jensen, Bente R

2013-04-01

To evaluate the effect of body weight-supported progressive high-intensity locomotor training in Parkinson's disease (PD) on (1) clinical status; (2) quality of life; and (3) gait capacity. Open-label, fixed sequence crossover study. University motor control laboratory. Patients (N=13) with idiopathic PD (Hoehn and Yahr stage 2 or 3) and stable medication use. Patients completed an 8-week (3 × 1h/wk) training program on a lower-body positive-pressure treadmill. Body weight support was used to facilitate increased intensity and motor challenges during treadmill training. The training program contained combinations of (1) running and walking intervals, (2) the use of sudden changes (eg, in body weight support and speed), (3) different types of locomotion (eg, chassé, skipping, and jumps), and (4) sprints at 50 percent body weight. The Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Questionnaire-39 items (PDQ-39), and the six-minute walk test were conducted 8 weeks before and pre- and posttraining. At the end of training, statistically significant improvements were found in all outcome measures compared with the control period. Total MDS-UPDRS score changed from (mean ± 1SD) 58±18 to 47±18, MDS-UPDRS motor part score changed from 35±10 to 29±12, PDQ-39 summary index score changed from 22±13 to 13±12, and the six-minute walking distance changed from 576±93 to 637±90m. Body weight-supported progressive high-intensity locomotor training is feasible and well tolerated by patients with PD. The training improved clinical status, quality of life, and gait capacity significantly. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effect of virtual reality training on walking distance and physical fitness in individuals with Parkinson's disease.

PubMed

de Melo, Gileno Edu Lameira; Kleiner, Ana Francisca Rozin; Lopes, Jamile Benite Palma; Dumont, Arislander Jonathan Lopes; Lazzari, Roberta Delasta; Galli, Manuela; Oliveira, Claudia Santos

2018-04-07

To evaluate the effects of gait training with virtual reality (VR) on walking distance and physical fitness in individuals with Parkinson's Disease (PD). Thirty-seven individuals with PD participated in this prospective, randomized, controlled clinical trial. They were randomly allocated to a control group submitted to conventional training (n = 12), a treadmill group submitted to gait training on a treadmill (n = 13) and a VR group submitted to gait training using the XboxTM (n = 12). Clinical measures, gait variables and the Six-Minute Walk Test (6MWT) were evaluated: pre-intervention, after one intervention session, post-intervention and follow up (30 days after intervention). The VR and treadmill groups travelled longer distances on the 6MWT and had faster gait speed in comparison to the control group. The VR and treadmill groups demonstrated an increase in pre-6MWT HR. The VR group had more intense HR after the first session and throughout training, but these gains were not maintained at the follow-up. The present findings demonstrate that gait training with a VR program is as effective as treadmill training with regard to gains in walking distance and improvements in temporal gait variables in individuals with PD.

The boot camp program for lumbar spinal stenosis: a protocol for a randomized controlled trial.

PubMed

Ammendolia, Carlo; Côté, Pierre; Rampersaud, Y Raja; Southerst, Danielle; Budgell, Brian; Bombardier, Claire; Hawker, Gillian

2016-01-01

Lumbar spinal stenosis (LSS) causing neurogenic claudication is a leading cause of pain, disability and loss of independence in older adults. The prevalence of lumbar spinal stenosis is growing rapidly due to an aging population. The dominant limitation in LSS is walking ability. Postural, physical and psychosocial factors can impact symptoms and functional ability. LSS is the most common reason for spine surgery in older adults yet the vast majority of people with LSS receive non-surgical treatment. What constitutes effective non-surgical treatment is unknown. The purpose of this study is to evaluate the effectiveness of a multi-modal and self-management training program, known as the Boot Camp Program for LSS aimed at improving walking ability and other relevant patient-centred outcomes. We will use a pragmatic two-arm randomized controlled single blinded (assessor) study design. Eligible and consenting participants will be randomized to receive from licensed chiropractors either a 6-week (twice weekly) self-management training program (manual therapy, education, home exercises) with an instructional workbook and video and a pedometer or a single instructional session with an instructional workbook and video and pedometer. The main outcome measure will be the self-paced walking test measured at 6 months. We will also assess outcomes at 8 weeks and 3 and 12 months. Symptoms and functional limitations in LSS are variable and influenced by changes in spinal alignment. Physical and psychological factors result in chronic disability for patients with LSS. The Boot Camp Program is a 6-week self-management training program aimed at the multi-faceted aspects of LSS and trains individuals to use self-management strategies. The goal is to provide life-long self-management strategies that maximize walking and overall functional abilities and quality of life. ClinicalTrials.gov ID: NCT02592642.

The braking force in walking: age-related differences and improvement in older adults with exergame training.

PubMed

Maillot, Pauline; Perrot, Alexandra; Hartley, Alan; Do, Manh-Cuong

2014-10-01

The purposes of this present research were, in the first study, to determine whether age impacts a measure of postural control (the braking force in walking) and, in a second study, to determine whether exergame training in physically-simulated sport activity would show transfer, increasing the braking force in walking and also improving balance assessed by clinical measures, functional fitness, and health-related quality of life in older adults. For the second study, the authors developed an active video game training program (using the Wii system) with a pretest-training-posttest design comparing an experimental group (24 1-hr sessions of training) with a control group. Participants completed a battery comprising balance (braking force in short and normal step conditions), functional fitness (Senior Fitness Test), and health-related quality of life (SF-36). Results show that 12 weeks of video game-based exercise program training improved the braking force in the normal step condition, along with the functional fitness of lower limb strength, cardiovascular endurance, and motor agility, as measured by the Senior Fitness Test. Only the global mental dimension of the SF-36 was sensitive to exergame practice. Exergames appear to be an effective way to train postural control in older adults. Because of the multimodal nature of the activity, exergames provide an effective tool for remediation of age-related problems.

Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial.

PubMed

Macko, Richard F; Ivey, Frederick M; Forrester, Larry W; Hanley, Daniel; Sorkin, John D; Katzel, Leslie I; Silver, Kenneth H; Goldberg, Andrew P

2005-10-01

Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke. Sixty-one adults with chronic hemiparetic gait after ischemic stroke (>6 months) were randomized to 6 months (3x/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (Vo2 peak), o2 consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training. Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, delta% T-AEX versus R-CONTROL, P<0.005). Group-by-time analyses revealed T-AEX improved ambulatory performance on 6-minute walks (30% versus 11%, P<0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, P<0.05). In the T-AEX group, increasing training velocity predicted improved Vo2 peak (r=0.43, P<0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (r=0.41, P<0.05), but not fitness gains. T-AEX improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care. Specific characteristics of training may determine the nature of exercise-mediated adaptations.

A 4-week neuromuscular training program and gait patterns at the ankle joint.

PubMed

Coughlan, Garrett; Caulfield, Brian

2007-01-01

Previous research into the rehabilitation of ankle sprains has primarily focused on outcome measures that do not replicate functional activities, thus making it difficult to extrapolate the results relative to the weight-bearing conditions under which most ankle sprains occur. To measure the effects of a training program on gait during walking and running in an active athletic population. Matched-pairs, controlled trial. University motion analysis laboratory. Ten subjects from an athletic population (7 healthy, 3 with functional ankle instability: age = 25.8 +/- 3.9 years, height = 177.6 +/- 6.1 cm, mass = 66.8 +/- 7.4 kg) and 10 controls matched for age, sex, activity, and ankle instability (7 healthy, 3 with functional ankle instability: age = 27.4 +/- 5.8 years, height = 178.7 +/- 10.8 cm, mass = 71.6 +/- 10.0 kg). A 4-week neuromuscular training program undertaken by the treatment group. We measured ankle position and velocity in the frontal (x) and sagittal (y) planes in all subjects during treadmill walking and running for the periods 100 milliseconds before heel strike, at heel strike, and 100 milliseconds after heel strike. A 4-week neuromuscular training program resulted in no significant changes in ankle position or velocity during treadmill walking and running. The mechanisms by which neuromuscular training improves function in normal subjects and those with functional ankle instability do not appear to result in measurable changes in gait kinematics. Our findings raise issues regarding methods of ankle sprain rehabilitation and the measurement of their effectiveness in improving functional activities. Further research in a larger population with functional ankle instability is necessary.

Walking training associated with virtual reality-based training increases walking speed of individuals with chronic stroke: systematic review with meta-analysis.

PubMed

Rodrigues-Baroni, Juliana M; Nascimento, Lucas R; Ada, Louise; Teixeira-Salmela, Luci F

2014-01-01

To systematically review the available evidence on the efficacy of walking training associated with virtual reality-based training in patients with stroke. The specific questions were: Is walking training associated with virtual reality-based training effective in increasing walking speed after stroke? Is this type of intervention more effective in increasing walking speed, than non-virtual reality-based walking interventions? A systematic review with meta-analysis of randomized clinical trials was conducted. Participants were adults with chronic stroke and the experimental intervention was walking training associated with virtual reality-based training to increase walking speed. The outcome data regarding walking speed were extracted from the eligible trials and were combined using a meta-analysis approach. Seven trials representing eight comparisons were included in this systematic review. Overall, the virtual reality-based training increased walking speed by 0.17 m/s (IC 95% 0.08 to 0.26), compared with placebo/nothing or non-walking interventions. In addition, the virtual reality-based training increased walking speed by 0.15 m/s (IC 95% 0.05 to 0.24), compared with non-virtual reality walking interventions. This review provided evidence that walking training associated with virtual reality-based training was effective in increasing walking speed after stroke, and resulted in better results than non-virtual reality interventions.

Walking training associated with virtual reality-based training increases walking speed of individuals with chronic stroke: systematic review with meta-analysis

PubMed Central

Rodrigues-Baroni, Juliana M.; Nascimento, Lucas R.; Ada, Louise; Teixeira-Salmela, Luci F.

2014-01-01

OBJECTIVE: To systematically review the available evidence on the efficacy of walking training associated with virtual reality-based training in patients with stroke. The specific questions were: Is walking training associated with virtual reality-based training effective in increasing walking speed after stroke? Is this type of intervention more effective in increasing walking speed, than non-virtual reality-based walking interventions? METHOD: A systematic review with meta-analysis of randomized clinical trials was conducted. Participants were adults with chronic stroke and the experimental intervention was walking training associated with virtual reality-based training to increase walking speed. The outcome data regarding walking speed were extracted from the eligible trials and were combined using a meta-analysis approach. RESULTS: Seven trials representing eight comparisons were included in this systematic review. Overall, the virtual reality-based training increased walking speed by 0.17 m/s (IC 95% 0.08 to 0.26), compared with placebo/nothing or non-walking interventions. In addition, the virtual reality-based training increased walking speed by 0.15 m/s (IC 95% 0.05 to 0.24), compared with non-virtual reality walking interventions. CONCLUSIONS: This review provided evidence that walking training associated with virtual reality-based training was effective in increasing walking speed after stroke, and resulted in better results than non-virtual reality interventions. PMID:25590442

Gait Training Improves Performance in Healthy Adults Exposed to Novel Discordant Conditions

NASA Technical Reports Server (NTRS)

Batson, Crystal D.; Brady, Rachel A.; Peters, Brian T.; Mulavara, Ajitkumar P.; Bloomberg, Jacob J.

2010-01-01

After they return to Earth, astronauts experience sensorimotor disturbances that disrupt their ability to walk. We have previously shown that training with a variety of sensorimotor adaptive challenges enhances the capability of adapting to novel sensorimotor conditions. We are currently developing a sensorimotor adaptability (SA) training program designed to facilitate recovery of function after gravitational transitions. The purpose of this study was to determine whether trained subjects could transfer learned skills from one discordant visuo-proprioceptive environment to another. During three sessions, subjects walked at 2.5 km/h on a treadmill mounted on a motion base platform. Ten subjects trained with a combination of lateral treadmill translation and superimposed sinusoidal lateral optic flow that was presented on a large screen positioned in front of them. Ten controls completed the same training schedule while viewing only the forward optic flow with no visual or physical oscillation. Twenty minutes after the final training session, all subjects completed a 2-minute trial with a novel combination of visual and treadmill roll perturbations not previously experienced during the training (Transfer Test). Compared to the untrained group, participants who received SA training showed faster reaction times and, based on a composite score derived from stride frequency, heart rate, and reaction time, an overall enhanced performance. Our results showed that an SA training program can improve overall walking performance when subjects are exposed to novel incongruent sensory environments. This training has application for both enhancing adaptive responses in astronauts and reducing fall and injury risk in the elderly.

Walking adaptability therapy after stroke: study protocol for a randomized controlled trial.

PubMed

Timmermans, Celine; Roerdink, Melvyn; van Ooijen, Marielle W; Meskers, Carel G; Janssen, Thomas W; Beek, Peter J

2016-08-26

Walking in everyday life requires the ability to adapt walking to the environment. This adaptability is often impaired after stroke, and this might contribute to the increased fall risk after stroke. To improve safe community ambulation, walking adaptability training might be beneficial after stroke. This study is designed to compare the effects of two interventions for improving walking speed and walking adaptability: treadmill-based C-Mill therapy (therapy with augmented reality) and the overground FALLS program (a conventional therapy program). We hypothesize that C-Mill therapy will result in better outcomes than the FALLS program, owing to its expected greater amount of walking practice. This is a single-center parallel group randomized controlled trial with pre-intervention, post-intervention, retention, and follow-up tests. Forty persons after stroke (≥3 months) with deficits in walking or balance will be included. Participants will be randomly allocated to either C-Mill therapy or the overground FALLS program for 5 weeks. Both interventions will incorporate practice of walking adaptability and will be matched in terms of frequency, duration, and therapist attention. Walking speed, as determined by the 10 Meter Walking Test, will be the primary outcome measure. Secondary outcome measures will pertain to walking adaptability (10 Meter Walking Test with context or cognitive dual-task and Interactive Walkway assessments). Furthermore, commonly used clinical measures to determine walking ability (Timed Up-and-Go test), walking independence (Functional Ambulation Category), balance (Berg Balance Scale), and balance confidence (Activities-specific Balance Confidence scale) will be used, as well as a complementary set of walking-related assessments. The amount of walking practice (the number of steps taken per session) will be registered using the treadmill's inbuilt step counter (C-Mill therapy) and video recordings (FALLS program). This process measure will be compared between the two interventions. This study will assess the effects of treadmill-based C-Mill therapy compared with the overground FALLS program and thereby the relative importance of the amount of walking practice as a key aspect of effective intervention programs directed at improving walking speed and walking adaptability after stroke. Netherlands Trial Register NTR4030 . Registered on 11 June 2013, amendment filed on 17 June 2016.

Methods for a Randomized Trial of Weight-Supported Treadmill Training versus Conventional Training for Walking during Inpatient Rehabilitation after Incomplete Traumatic Spinal Cord Injury

PubMed Central

Dobkin, Bruce H.; Apple, David; Barbeau, Hugues; Basso, Michele; Behrman, Andrea; Deforge, Dan; Ditunno, John; Dudley, Gary; Elashoff, Robert; Fugate, Lisa; Harkema, Susan; Saulino, Michael; Scott, Michael

2014-01-01

The authors describe the rationale and methodology for the first prospective, multicenter, randomized clinical trial (RCT) of a task-oriented walking intervention for subjects during early rehabilitation for an acute traumatic spinal cord injury (SCI). The experimental strategy, body weight–supported treadmill training (BWSTT), allows physical therapists to systematically train patients to walk on a treadmill at increasing speeds typical of community ambulation with increasing weight bearing. The therapists provide verbal and tactile cues to facilitate the kinematic, kinetic, and temporal features of walking. Subjects were randomly assigned to a conventional therapy program for mobility versus the same intensity and duration of a combination of BWSTT and over-ground locomotor retraining. Subjects had an incomplete SCI (American Spinal Injury Association grades B, C, and D) from C-4 to T-10 (upper motoneuron group) or from T-11 to L-3 (lower motoneuron group). Within 8 weeks of a SCI, 146 subjects were entered for 12 weeks of intervention. The 2 single-blinded primary outcome measures are the level of independence for ambulation and, for those who are able to walk, the maximal speed for walking 50 feet, tested 6 and 12 months after randomization. The trial’s methodology offers a model for the feasibility of translating neuroscientific experiments into a RCT to develop evidence-based rehabilitation practices. PMID:14503436

Walking can be more effective than balance training in fall prevention among community-dwelling older adults.

PubMed

Okubo, Yoshiro; Osuka, Yosuke; Jung, Songee; Rafael, Figueroa; Tsujimoto, Takehiko; Aiba, Tatsuya; Kim, Teaho; Tanaka, Kiyoji

2016-01-01

To examine the effects of walking on falls among community-dwelling older adults while accounting for exposures. A total of 90 older adults, ranging in age from 65 to 79 years, were allocated into either the walking (brisk walking, n = 50) or the balance (balance and strength training, n = 40) group to participate in a 3-month supervised and 13-month unsupervised fall-prevention program held from 2012 to 2014 in Japan. Falls and trips that occurred during the 16-month period were monitored with a monthly fall calendar. The risk of falls and trips was evaluated by person-year, physically active person-day and person-step. The walking group showed a significant reduction in the fall risk when evaluated by the falls per physically active person-day (rate ratio 0.38, 95% confidence interval 0.19-0.77) and falls per person-step (rate ratio 0.47, 95% confidence interval 0.26-0.85) compared with the balance group. In contrast, the number of trips significantly increased with walking, even when evaluated as trips per physically active person-day (rate ratio 1.50, 95% confidence interval 1.12-2.00). The present findings suggest that walking among community-dwelling older adults can be more effective for fall prevention than balance training. However, because walking can induce more trips, walking should not be recommended for older adults who are susceptible to falling or frailty. © 2015 Japan Geriatrics Society.

A Controlled Trial of the Efficacy of a Training Walking Program in Patients Recovering from Abdominal Aortic Aneurysm Surgery.

PubMed

Wnuk, Bartosz R; Durmała, Jacek; Ziaja, Krzysztof; Kotyla, Przemysław; Woźniewski, Marek; Błaszczak, Edward

2016-01-01

Major surgical procedures as well as general anesthesia contribute to muscle weakness and posture instability and may result in increased postoperative complications and functional disorders resulting from an elective operation. We aim to state the significance of backward walking as a form of interval march training with patients after abdominal aortic aneurysm surgery. Sixty-five patients were randomly divided into three subgroups and three various models of physiotherapy were applied. The participants were males, aged 65-75 years, with stable cardiologic status, absence of neurological disorders, and non-symptomatic aneurysm - non-ruptured, no pain complaints and no motor system impairments. The control group had only routine physiotherapy, since therapeutic groups I and II also had walking exercises, forward in group II and backward in group I. Both experimental groups were applied interval training. The patient data analyzed was as follows: hospitalization period-days; 6-min walking test-distance (m), training heart rate (1/min), mean speed (km/h), MET; spirometry test-FVC(L), FEV1(L), FEV1/FVC and PEF(L/s). The hospital stay period in all groups did not vary significantly. Statistical analysis showed that patients with backward walking had a statistically significantly lower reduction of walking distance in the corridor test when compared to the control group (p < 0.05). After the operation, a significant reduction of mean speed in the control group was noted in comparison with both the forward and backward walking groups (p < 0.05). No significant differences were noted between the experimental groups in average walking speed as well as in heart rate in all observed groups. Physical training applied to patients after major abdominal aortic aneurysm surgery influences sustaining the level of exercise tolerance to a small extent. Both backward and forward walking seem to be alternative methods when compared to classic post-surgery physiotherapy.

Body weight-supported treadmill training vs. overground walking training for persons with chronic stroke: a pilot randomized controlled trial.

PubMed

Combs-Miller, Stephanie A; Kalpathi Parameswaran, Anu; Colburn, Dawn; Ertel, Tara; Harmeyer, Amanda; Tucker, Lindsay; Schmid, Arlene A

2014-09-01

To compare the effects of body weight-supported treadmill training and overground walking training when matched for task and dose (duration/frequency/intensity) on improving walking function, activity, and participation after stroke. Single-blind, pilot randomized controlled trial with three-month follow-up. University and community settings. A convenience sample of participants (N = 20) at least six months post-stroke and able to walk independently were recruited. Thirty-minute walking interventions (body weight-supported treadmill training or overground walking training) were administered five times a week for two weeks. Intensity was monitored with the Borg Rating of Perceived Exertion Scale at five-minute increments to maintain a moderate training intensity. Walking speed (comfortable/fast 10-meter walk), walking endurance (6-minute walk), spatiotemporal symmetry, and the ICF Measure of Participation and ACTivity were assessed before, immediately after, and three months following the intervention. The overground walking training group demonstrated significantly greater improvements in comfortable walking speed compared with the body weight-supported treadmill training group immediately (change of 0.11 m/s vs. 0.06 m/s, respectively; p = 0.047) and three months (change of 0.14 m/s vs. 0.08 m/s, respectively; p = 0.029) after training. Only the overground walking training group significantly improved comfortable walking speed (p = 0.001), aspects of gait symmetry (p = 0.032), and activity (p = 0.003) immediately after training. Gains were maintained at the three-month follow-up (p < 0.05) for all measures except activity. Improvements in participation were not demonstrated. Overgound walking training was more beneficial than body weight-supported treadmill training at improving self-selected walking speed for the participants in this study. © The Author(s) 2014.

[Application of the 6-Minute Walking Test and Shuttle Walking Test in the Exercise Tests of Patients With COPD].

PubMed

Ho, Chiung-Fang; Maa, Suh-Hwa

2016-08-01

Exercise training improves the management of stable chronic obstructive pulmonary disease (COPD). COPD patients benefit from exercise training programs in terms of improved VO2 peak values and decreased dyspnea, fatigue, hospital admissions, and rates of mortality, increasing exercise capacity and health-related quality of life (HRQOL). COPD is often associated with impairment in exercise tolerance. About 51% of patients have a limited capacity for normal activity, which often further degrades exercise capacity, creating a vicious circle. Exercise testing is highly recommended to assess a patient's individualized functions and limitations in order to determine the optimal level of training intensity prior to initiating an exercise-training regimen. The outcomes of exercise testing provide a powerful indicator of prognosis in COPD patients. The six-minute walking test (6MWT) and the incremental shuttle-walking test (ISWT) are widely used in exercise testing to measure a patient's exercise ability by walking distances. While nursing-related articles published in Taiwan frequently cite and use the 6MWT to assess exercise capacity in COPD patients, the ISWT is rarely used. This paper introduces the testing method, strengths and weaknesses, and application of the two tests in order to provide clinical guidelines for assessing the current exercise capacity of COPD patients.

Single- and Dual-Task Balance Training Are Equally Effective in Youth

PubMed Central

Lüder, Benjamin; Kiss, Rainer; Granacher, Urs

2018-01-01

Due to maturation of the postural control system and secular declines in motor performance, adolescents experience deficits in postural control during standing and walking while concurrently performing cognitive interference tasks. Thus, adequately designed balance training programs may help to counteract these deficits. While the general effectiveness of youth balance training is well-documented, there is hardly any information available on the specific effects of single-task (ST) versus dual-task (DT) balance training. Therefore, the objectives of this study were (i) to examine static/dynamic balance performance under ST and DT conditions in adolescents and (ii) to study the effects of ST versus DT balance training on static/dynamic balance under ST and DT conditions in adolescents. Twenty-eight healthy girls and boys aged 12–13 years were randomly assigned to either 8 weeks of ST or DT balance training. Before and after training, postural sway and spatio-temporal gait parameters were registered under ST (standing/walking only) and DT conditions (standing/walking while concurrently performing an arithmetic task). At baseline, significantly slower gait speed (p < 0.001, d = 5.1), shorter stride length (p < 0.001, d = 4.8), and longer stride time (p < 0.001, d = 3.8) were found for DT compared to ST walking but not standing. Training resulted in significant pre–post decreases in DT costs for gait velocity (p < 0.001, d = 3.1), stride length (-45%, p < 0.001, d = 2.4), and stride time (-44%, p < 0.01, d = 1.9). Training did not induce any significant changes (p > 0.05, d = 0–0.1) in DT costs for all parameters of secondary task performance during standing and walking. Training produced significant pre–post increases (p = 0.001; d = 1.47) in secondary task performance while sitting. The observed increase was significantly greater for the ST training group (p = 0.04; d = 0.81). For standing, no significant changes were found over time irrespective of the experimental group. We conclude that adolescents showed impaired DT compared to ST walking but not standing. ST and DT balance training resulted in significant and similar changes in DT costs during walking. Thus, there appears to be no preference for either ST or DT balance training in adolescents. PMID:29928248

Single- and Dual-Task Balance Training Are Equally Effective in Youth.

PubMed

Lüder, Benjamin; Kiss, Rainer; Granacher, Urs

2018-01-01

Due to maturation of the postural control system and secular declines in motor performance, adolescents experience deficits in postural control during standing and walking while concurrently performing cognitive interference tasks. Thus, adequately designed balance training programs may help to counteract these deficits. While the general effectiveness of youth balance training is well-documented, there is hardly any information available on the specific effects of single-task (ST) versus dual-task (DT) balance training. Therefore, the objectives of this study were (i) to examine static/dynamic balance performance under ST and DT conditions in adolescents and (ii) to study the effects of ST versus DT balance training on static/dynamic balance under ST and DT conditions in adolescents. Twenty-eight healthy girls and boys aged 12-13 years were randomly assigned to either 8 weeks of ST or DT balance training. Before and after training, postural sway and spatio-temporal gait parameters were registered under ST (standing/walking only) and DT conditions (standing/walking while concurrently performing an arithmetic task). At baseline, significantly slower gait speed ( p < 0.001, d = 5.1), shorter stride length ( p < 0.001, d = 4.8), and longer stride time ( p < 0.001, d = 3.8) were found for DT compared to ST walking but not standing. Training resulted in significant pre-post decreases in DT costs for gait velocity ( p < 0.001, d = 3.1), stride length (-45%, p < 0.001, d = 2.4), and stride time (-44%, p < 0.01, d = 1.9). Training did not induce any significant changes ( p > 0.05, d = 0-0.1) in DT costs for all parameters of secondary task performance during standing and walking. Training produced significant pre-post increases ( p = 0.001; d = 1.47) in secondary task performance while sitting. The observed increase was significantly greater for the ST training group ( p = 0.04; d = 0.81). For standing, no significant changes were found over time irrespective of the experimental group. We conclude that adolescents showed impaired DT compared to ST walking but not standing. ST and DT balance training resulted in significant and similar changes in DT costs during walking. Thus, there appears to be no preference for either ST or DT balance training in adolescents.

Efficacy of treadmill exercises on arterial blood oxygenation, oxygen consumption and walking distance in healthy elderly people: a controlled trial.

PubMed

Bichay, Ashraf Adel Fahmy; Ramírez, Juan M; Núñez, Víctor M; Lancho, Carolina; Poblador, María S; Lancho, José L

2016-05-25

Regular physical exercise and healthy lifestyle can improve aerobic power of the elderly, although lung capacity gradually deteriorates with age. The aims of the study are: a) to evaluate the therapeutic effect of a treadmill exercise program on arterial blood oxygenation (SaO2), maximum oxygen consumption (VO2max) and maximum walking distance (MWD) in healthy elderly people; b) to examine the outcome of the program at a supervised short-term and at an unsupervised long-term. A prospective, not-randomized controlled intervention trial (NRCT) was conducted. Eighty participants were allocated into two homogeneous groups (training group, TG, n = 40; control group, CG, n = 40). Each group consisted of 20 men and 20 women. Pre-intervention measures of SaO2, VO2max and MWD were taken of each participant 1-week before the training program to establish the baseline. Also, during the training program, the participants were followed up at the 12, 30 and 48th week. The exercise program consisted of walking on a treadmill with fixed 0 % grade of inclination 3 times weekly for 48 weeks; the first 12 weeks were supervised and the remaining 36 weeks of the program were unsupervised. Participants in the control group were encouraged to walk twice a week during 45 min, and received standard recommendations for proper health. Related to the baseline, the SaO2, VO2max, and MWD is greater in the intervention group at the 12(th) (p <.001), 30(th) (p <.001) and 48(th) week (p <.001). Compared with the control group, there was also a significant improvement of SaO2, VO2max, and MWD valuesin the intervention group (p <.001) at the 12(th) (p <.001), 30(th) (p <.001) and 48(th) week (p <.001). Supervised intervention shows greater improvement of SaO2, VO2max, and MWD values than in the unsupervised one. These results show that performing moderate exercise, specifically walking 3 days a week, is highly recommended for healthy older people, improving aerobic power. Current Controlled Trials ISRCTN12621097 .

Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes.

PubMed

Gainey, Atikarn; Himathongkam, Thep; Tanaka, Hirofumi; Suksom, Daroonwan

2016-06-01

To investigate and compare the effects of Buddhist walking meditation and traditional walking on glycemic control and vascular function in patients with type 2 diabetes mellitus. Twenty three patients with type 2 diabetes (50-75 years) were randomly allocated into traditional walking exercise (WE; n=11) or Buddhism-based walking meditation exercise (WM; n=12). Both groups performed a 12-week exercise program that consisted of walking on the treadmill at exercise intensity of 50-70% maximum heart rate for 30min/session, 3 times/week. In the WM training program, the participants performed walking on the treadmill while concentrated on foot stepping by voiced "Budd" and "Dha" with each foot step that contacted the floor to practice mindfulness while walking. After 12 weeks, maximal oxygen consumption increased and fasting blood glucose level decreased significantly in both groups (p<0.05). Significant decrease in HbA1c and both systolic and diastolic blood pressure were observed only in the WM group. Flow-mediated dilatation increased significantly (p<0.05) in both exercise groups but arterial stiffness was improved only in the WM group. Blood cortisol level was reduced (p<0.05) only in the WM group. Buddhist walking meditation exercise produced a multitude of favorable effects, often superior to traditional walking program, in patients with type 2 diabetes. Copyright © 2016 Elsevier Ltd. All rights reserved.

A 4-Week Neuromuscular Training Program and Gait Patterns at the Ankle Joint

PubMed Central

Coughlan, Garrett; Caulfield, Brian

2007-01-01

Context: Previous research into the rehabilitation of ankle sprains has primarily focused on outcome measures that do not replicate functional activities, thus making it difficult to extrapolate the results relative to the weight-bearing conditions under which most ankle sprains occur. Objective: To measure the effects of a training program on gait during walking and running in an active athletic population. Design: Matched-pairs, controlled trial. Setting: University motion analysis laboratory. Patients or Other Participants: Ten subjects from an athletic population (7 healthy, 3 with functional ankle instability: age = 25.8 ± 3.9 years, height = 177.6 ± 6.1 cm, mass = 66.8 ± 7.4 kg) and 10 controls matched for age, sex, activity, and ankle instability (7 healthy, 3 with functional ankle instability: age = 27.4 ± 5.8 years, height = 178.7 ± 10.8 cm, mass = 71.6 ± 10.0 kg). Intervention(s): A 4-week neuromuscular training program undertaken by the treatment group. Main Outcome Measure(s): We measured ankle position and velocity in the frontal (x) and sagittal (y) planes in all subjects during treadmill walking and running for the periods 100 milliseconds before heel strike, at heel strike, and 100 milliseconds after heel strike. Results: A 4-week neuromuscular training program resulted in no significant changes in ankle position or velocity during treadmill walking and running. Conclusions: The mechanisms by which neuromuscular training improves function in normal subjects and those with functional ankle instability do not appear to result in measurable changes in gait kinematics. Our findings raise issues regarding methods of ankle sprain rehabilitation and the measurement of their effectiveness in improving functional activities. Further research in a larger population with functional ankle instability is necessary. PMID:17597944

Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: a pilot study.

PubMed

Peruzzi, Agnese; Cereatti, Andrea; Della Croce, Ugo; Mirelman, Anat

2016-01-01

Gait and cognitive deficits are common in multiple sclerosis (MS) and are negatively affected during dual-task walking. Treadmill (TM) training has been previously used to preserve locomotor activity in MS. Virtual reality (VR) engages the user in cognitive and motor activities simultaneously. A training combining TM and VR has been successfully adopted in several neurological diseases, but not in MS. This study aims at investigating the feasibility of a VR-based TM training program on gait of subjects with MS. Eight persons with relapsing-remitting MS were recruited to participate in a six-week VR-based TM training program. Gait analysis was performed both in single and dual task conditions. Clinical tests were used to assess walking endurance and obstacle negotiation. All the evaluations were performed before, immediately and one month after the training. Gait speed and stride length improved in dual task post-intervention and were retained at follow-up. An improved ability in negotiating obstacles was found across the evaluations. VR-based TM training program is feasible and safe for MS subjects with moderate disabilities and may positively affect gait under complex conditions, such as dual tasking and obstacle negotiation. Copyright © 2015. Published by Elsevier B.V.

Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial.

PubMed

José, Anderson; Dal Corso, Simone

2016-04-01

Among people who are hospitalised for community-acquired pneumonia, does an inpatient exercise-based rehabilitation program improve functional outcomes, symptoms, quality of life and length of hospital stay more than a respiratory physiotherapy regimen? Randomised trial with concealed allocation, intention-to-treat analysis and blinding of some outcomes. Forty-nine adults hospitalised for community-acquired pneumonia. The experimental group (n=32) underwent a physical training program that included warm-up, stretching, peripheral muscle strength training and walking at a controlled speed for 15 minutes. The control group (n=17) underwent a respiratory physiotherapy regimen that included percussion, vibrocompression, respiratory exercises and free walking. The intervention regimens lasted 8 days. The primary outcome was the Glittre Activities of Daily Living test, which assesses the time taken to complete a series of functional tasks (eg, rising from a chair, walking, stairs, lifting and bending). Secondary outcomes were distance walked in the incremental shuttle walk test, peripheral muscle strength, quality of life, dyspnoea, lung function, C-reactive protein and length of hospital stay. Measures were taken 1 day before and 1 day after the intervention period. There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test (mean between-group difference 39 seconds, 95% CI 20 to 59) and the incremental shuttle walk test (mean between-group difference 130 m, 95% CI 77 to 182). There were also significantly greater improvements in quality of life, dyspnoea and peripheral muscle strength in the experimental group than in the control group. There were no between-group differences in lung function, C-reactive protein or length of hospital stay. The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after standard respiratory physiotherapy. The exercise training program led to greater benefits in functional capacity, peripheral muscle strength, dyspnoea and quality of life. ClinicalTrials.gov, NCT02103400. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Aerobic training modulates T cell activation in elderly women with knee osteoarthritis

PubMed Central

Gomes, W.F.; Lacerda, A.C.R.; Brito-Melo, G.E.A.; Fonseca, S.F.; Rocha-Vieira, E.; Leopoldino, A.A.O.; Amorim, M.R.; Mendonça, V.A.

2016-01-01

Osteoarthritis of the knee (kOA) is a disease that mainly affects the elderly and can lead to major physical and functional limitations. However, the specific effects of walking, particularly on the immune system, are unknown. Therefore, this study aimed to analyze the effect of 12 weeks of walking (3×/week) on the leukocyte profile and quality of life (QL) of elderly women with kOA. Sixteen women (age: 67±4 years, body mass index: 28.07±4.16 kg/m2) participated in a walking program. The variables were assessed before and after 12 weeks of training with a progressively longer duration (30–55 min) and higher intensity (72–82% of HRmax determined using a graded incremental treadmill test). The QL was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and blood samples were collected for analysis with a cell counter and the San Fac flow cytometer. Walking training resulted in a 47% enhancement of the self-reported QL (P<0.05) and a 21% increase in the VO2max (P<0.0001) in elderly women with kOA. Furthermore, there was a reduction in CD4+ cells (pre=46.59±7%, post=44.58±9%, P=0.0189) and a higher fluorescence intensity for CD18+CD4+ (pre=45.30±10, post=64.27±33, P=0.0256) and CD18+CD8+ (pre=64.2±27, post=85.02±35, P=0.0130). In conclusion, the walking program stimulated leukocyte production, which may be related to the immunomodulatory effect of exercise. Walking also led to improvements in the QL and physical performance in elderly women with kOA. PMID:27828665

Countermeasures to Enhance Sensorimotor Adaptability

NASA Technical Reports Server (NTRS)

Bloomberg, J. J.; Peters, B. T.; Mulavara, A. P.; Brady, R. A.; Batson, C. C.; Miller, C. A.; Cohen, H. S.

2011-01-01

During exploration-class missions, sensorimotor disturbances may lead to disruption in the ability to ambulate and perform functional tasks during the initial introduction to a novel gravitational environment following a landing on a planetary surface. The goal of our current project is to develop a sensorimotor adaptability (SA) training program to facilitate rapid adaptation to novel gravitational environments. We have developed a unique training system comprised of a treadmill placed on a motion-base facing a virtual visual scene that provides an unstable walking surface combined with incongruent visual flow designed to enhance sensorimotor adaptability. We have conducted a series of studies that have shown: Training using a combination of modified visual flow and support surface motion during treadmill walking enhances locomotor adaptability to a novel sensorimotor environment. Trained individuals become more proficient at performing multiple competing tasks while walking during adaptation to novel discordant sensorimotor conditions. Trained subjects can retain their increased level of adaptability over a six months period. SA training is effective in producing increased adaptability in a more complex over-ground ambulatory task on an obstacle course. This confirms that for a complex task like walking, treadmill training contains enough of the critical features of overground walking to be an effective training modality. The structure of individual training sessions can be optimized to promote fast/strategic motor learning. Training sessions that each contain short-duration exposures to multiple perturbation stimuli allows subjects to acquire a greater ability to rapidly reorganize appropriate response strategies when encountering a novel sensory environment. Individual sensory biases (i.e. increased visual dependency) can predict adaptive responses to novel sensory environments suggesting that customized training prescriptions can be developed to enhance adaptability. These results indicate that SA training techniques can be added to existing treadmill exercise equipment and procedures to produce a single integrated countermeasure system to improve performance of astro/cosmonauts during prolonged exploratory space missions.

An exploratory qualitative study of the meaning and value of a running/walking program for women after a diagnosis of breast cancer.

PubMed

Brunet, Jennifer; Saunders, Stephanie; Gifford, Wendy; Thomas, Roanne; Hamilton, Ryan

2018-05-01

To generate insights into the personal meaning and value of a running/walking program for women after a diagnosis of breast cancer. After completing a 12-week running/walking program with a 5-km training goal, eight women were interviewed and seven participated in a focus group. The interviews and focus group were audio-recorded and transcribed verbatim. Data were thematically analyzed. Data portrayed the personal benefits and value of the clinic. Four themes were identified: (1) receiving practical information and addressing targeted concerns, (2) pushing personal limits, (3) enabling a committed mindset, and (4) seeing benefits and challenges of running/walking with a group. Findings provide initial understanding of how women experience a running/walking program after a diagnosis of breast cancer and what they find to be important about their experiences. The range of positive benefits experienced by women suggests a running/walking program can help fill a gap in care for women diagnosed with breast cancer, and thus be part of cancer rehabilitation. However, because some women felt isolated at times, future research should seek to examine how running/walking programs can be modified and tailored so that all women find it socially beneficial. Implications for Rehabilitation The diagnosis and treatment of breast cancer can result in side effects and increase the risk of long-term disability. Physical activity can help women manage the side effects and lessen the risk of long-term disability. In a relatively small sample, this study shows that participation in a running/walking program can be an important part of breast cancer recovery.

Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial.

PubMed

Halvarsson, Alexandra; Franzén, Erika; Ståhle, Agneta

2015-04-01

To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects. Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up. Stockholm County, Sweden. Ninety-six older adults, aged 66-87, with verified osteoporosis. A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week. Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question - 'In general, are you afraid of falling?'), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument). Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls (p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task (p=0.003), at fast walking speed (p=0.008), and for advanced lower extremity physical function (p=0.034). This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis. © The Author(s) 2014.

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 4. Effect on physical self-concept and depression.

PubMed

Guest, R S; Klose, K J; Needham-Shropshire, B M; Jacobs, P L

1997-08-01

To determine whether persons with spinal cord injury (SCI) paraplegia who participated in an electrical stimulation walking program experienced changes in measures of physical self-concept and depression. Before-after trial. Human SCI applied research laboratory. Volunteer sample of 12 men and 3 women with SCI paraplegia, mean age 28.75 +/- 6.6yrs and mean duration of injury 3.8 +/- 3.2yrs. Thirty-two FNS ambulation training sessions using a commercially available system (Parastep 1). The hybrid system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. The Tennessee Self-Concept Scale (TSCS) and the Beck Depression Inventory (BDI) were administered before and after training. Only the Physical Self subscale of the TSCS was analyzed. After training, individual interviews were performed to assess participants' subjective reactions to the training program. A repeated measures analysis of variance indicated that desired directional and statistically significant changes occurred on the Physical Self subscale of the TSCS (F(1,14) = 8.54, p < .011) and on the BDI (F(1,14) = 5.42, p < .035). Subsequent to the ambulation training program there were statistically significant increases in physical self-concept scores and decreases in depression scores.

Walking during body-weight-supported treadmill training and acute responses to varying walking speed and body-weight support in ambulatory patients post-stroke.

PubMed

Aaslund, Mona Kristin; Helbostad, Jorunn Lægdheim; Moe-Nilssen, Rolf

2013-05-01

Rehabilitating walking in ambulatory patients post-stroke, with training that is safe, task-specific, intensive, and of sufficient duration, can be challenging. Some challenges can be met by using body-weight-supported treadmill training (BWSTT). However, it is not known to what degree walking characteristics are similar during BWSTT and overground walking. In addition, important questions regarding the training protocol of BWSTT remain unanswered, such as how proportion of body-weight support (BWS) and walking speed affect walking characteristics during training. The objective was therefore to investigate if and how kinematic walking characteristics are different between overground walking and treadmill walking with BWS in ambulatory patients post-stroke, and the acute response of altering walking speed and percent BWS during treadmill walking with BWS. A cross-sectional repeated-measures design was used. Ambulating patients post-stroke walked in slow, preferred, and fast walking speed overground and at comparable speeds on the treadmill with 20% and 40% BWS. Kinematic walking characteristics were obtained using a kinematic sensor attached over the lower back. Forty-four patients completed the protocol. Kinematic walking characteristics were similar during treadmill walking with BWS, compared to walking overground. During treadmill walking, choice of walking speed had greater impact on kinematic walking characteristics than proportion of BWS. Faster walking speeds tended to affect the kinematic walking characteristics positively. This implies that in order to train safely and with sufficient intensity and duration, therapists may choose to include BWSTT in walking rehabilitation also for ambulatory patients post-stroke without aggravating gait pattern during training.

The effects of an 8-week computerized cognitive training program in older adults: a study protocol for a randomized controlled trial.

PubMed

Ten Brinke, Lisanne F; Best, John R; Crockett, Rachel A; Liu-Ambrose, Teresa

2018-01-30

Given the world's aging population, it is important to identify strategies that promote healthy cognitive aging and minimize cognitive decline. Currently, no curative pharmaceutical therapy exists for cognitive impairment and dementia. As a result, there is much interest in lifestyle approaches. Specifically, complex mental activity, such as cognitive training, may be a promising method to combat cognitive decline in older adults. As such, the industry of commercial computerized cognitive training (CCT) applications has rapidly grown in the last decade. However, the efficacy of these commercial products is largely not established. Moreover, exercise is a recognized strategy for promoting cognitive outcomes in older adults and may augment the efficacy of computerized cognitive training applications. Therefore, we propose a proof-of-concept randomized controlled trial (RCT) to examine the effect of a commercial CCT program in community-dwelling older adults. An 8-week RCT to examine the effect of a commercial CCT program, alone and preceded by a 15-min brisk walk, on cognitive function and explore the underlying neural mechanisms in adults aged 65-85 years old. Participants will be randomized to one of three intervention groups: 1) Computerized cognitive training (FBT); 2) A 15-min brisk walk followed by computerized cognitive training (Ex-FBT); or 3) A combination of educational classes, sham cognitive training, and balanced and tone exercises (active control, BAT). Participants in all intervention groups will attend three one-hour classes per week over the course of the intervention. Participants will be assessed at baseline, trial completion, and 1-year post study completion (1-year follow-up). If results from this study show benefits for cognition at trial completion, CCT programs, alone or in combination with walking, might be a strategy to promote healthy cognitive aging in older adults. In addition, results from the 1-year follow-up measurement could provide important information regarding the long-term benefits of these CCT programs. ClinicalTrials.gov Protocol Registration System: NCT02564809; registered September 1, 2015.

The immediate and long-term effects of a walking-skill program compared to usual physiotherapy care in patients who have undergone total knee arthroplasty (TKA): a randomized controlled trial.

PubMed

Bruun-Olsen, Vigdis; Heiberg, Kristi Elisabeth; Wahl, Astrid Klopstad; Mengshoel, Anne Marit

2013-01-01

To examine the immediate and long-term effects of a walking-skill program compared with usual physiotherapy on physical function, pain and perceived self-efficacy in patients after total knee arthroplasty (TKA). A single blind randomized controlled trial design was applied. Fifty-seven patients with primary TKA, mean age of 69 years (SD ± 9), were randomly assigned to a walking-skill program emphasizing weight-bearing exercises or usual physiotherapy. Outcomes were assessed before the interventions started at 6 weeks postoperatively (T1), directly after the interventions at 12-14 weeks (T2) and 9 months after the interventions (T3). Walking was the primary outcome, assessed by the 6 min walk test (6MWT). The secondary outcomes were timed stair climbing, timed stands, Figure-of-eight test, Index of muscle function, active knee range of motion, Knee Injury and Osteoarthritis Outcome Score and self-efficacy score. From T1 to T2, a better 6MWT score was found in favor of the walking-skill program of 39 m (2-76), p = 0.04. The difference between the groups in 6MWT persisted at T3, 44 m (8-80), p = 0.02. No differences in other outcome measures were found. The walking-skill program had better effect on walking than usual physiotherapy. Weight bearing was tolerated. Implications for Rehabilitation Weight-bearing exercises are tolerated by the patients in the early stage after TKA. Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA.

A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients.

PubMed

Chua, Karen S G; Chee, Johnny; Wong, Chin J; Lim, Pang H; Lim, Wei S; Hoo, Chuan M; Ong, Wai S; Shen, Mira L; Yu, Wei S

2015-01-01

Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions. An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks. Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events. This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia.

Seasonal influence on adherence to and effects of an interval walking training program on sedentary female college students in Japan.

PubMed

Tanabe, Aiko; Masuki, Shizue; Nemoto, Ken-Ichi; Nose, Hiroshi

2018-04-01

Habitual exercise training is recommended to young people for their health promotion, but adherence may be influenced by atmospheric temperature (T a ) if performed outdoors. We compared the adherence to and the effects of a home-based interval walking training (IWT) program on sedentary female college students between winter and summer. For summer training over 176 days, 48 subjects (18-22 years old) were randomly divided into two groups: the control group (CNT summer , n = 24), which maintained a sedentary lifestyle as before, and the IWT group (IWT summer , n = 24), which performed IWT while energy expenditure was monitored by accelerometry. For winter training over 133 days, another group of 47 subjects (18-24 years old) was randomly divided into CNT winter (n = 24) and IWT winter (n = 23), as in summer. The peak T a per day was 26 ± 6 °C (SD) (range of 9-35 °C) in summer, much higher than 7 ± 5 °C (range of - 3-20 °C) in winter (P < 0.001). During a ~ 50-day vacation period, participants walked 2.1 ± 0.3 (SE) days/week in IWT summer , less than 4.2 ± 0.3 days/week in IWT winter (P < 0.001), with half of the energy expenditure/week for fast walking during the winter vacation (P < 0.02), whereas both IWT groups walked ~ 2 days/week during a school period (P > 0.8). After training, the peak aerobic capacity and knee flexion force increased in IWT winter (P < 0.01) but not in CNT winter (P > 0.3). Conversely, these parameters decreased in the summer groups. Thus, the adherence to and effects of IWT on sedentary female college students in Japan decreased in summer at least partially due to a high T a .

Motor Learning Versus StandardWalking Exercise in Older Adults with Subclinical Gait Dysfunction: A Randomized Clinical Trial

PubMed Central

Brach, Jennifer S.; Van Swearingen, Jessie M.; Perera, Subashan; Wert, David M.; Studenski, Stephanie

2013-01-01

Background Current exercise recommendationsfocus on endurance and strength, but rarely incorporate principles of motor learning. Motor learning exerciseis designed to address neurological aspects of movement. Motor learning exercise has not been evaluated in older adults with subclinical gait dysfunction. Objectives Tocompare motor learning versus standard exercise on measures of mobility and perceived function and disability. Design Single-blind randomized trial. Setting University research center. Participants Olderadults (n=40), mean age 77.1±6.0 years), who had normal walking speed (≥1.0 m/s) and impaired motor skill (Figure of 8 walk time > 8 s). Interventions The motor learning program (ML) incorporated goal-oriented stepping and walking to promote timing and coordination within the phases of the gait cycle. The standard program (S) employed endurance training by treadmill walking.Both included strength training and were offered twice weekly for one hour for 12 weeks. Measurements Primary outcomes included mobility performance (gait efficiency, motor skill in walking, gait speed, and walking endurance)and secondary outcomes included perceived function and disability (Late Life Function and Disability Instrument). Results 38 of 40 participants completed the trial (ML, n=18; S, n=20). ML improved more than Sin gait speed (0.13 vs. 0.05 m/s, p=0.008) and motor skill (−2.2 vs. −0.89 s, p<0.0001). Both groups improved in walking endurance (28.3 and 22.9m, but did not differ significantly p=0.14). Changes in gait efficiency and perceived function and disability were not different between the groups (p>0.10). Conclusion In older adults with subclinical gait dysfunction, motor learning exercise improved some parameters of mobility performance more than standard exercise. PMID:24219189

Home-based interventions improve trained, but not novel, dual-task balance performance in older adults: A randomized controlled trial.

PubMed

Wongcharoen, Suleeporn; Sungkarat, Somporn; Munkhetvit, Peeraya; Lugade, Vipul; Silsupadol, Patima

2017-02-01

The purpose of this study was to compare the efficacy of four different home-based interventions on dual-task balance performance and to determine the generalizability of the four trainings to untrained tasks. Sixty older adults, aged 65 and older, were randomly assigned to one of four home-based interventions: single-task motor training, single-task cognitive training, dual-task motor-cognitive training, and dual-task cognitive-cognitive training. Participants received 60-min individualized training sessions, 3 times a week for 4 weeks. Prior to and following the training program, participants were asked to walk under two single-task conditions (i.e. narrow walking and obstacle crossing) and two dual-task conditions (i.e. a trained narrow walking while performing verbal fluency task and an untrained obstacle crossing while counting backward by 3s task). A nine-camera motion capture system was used to collect the trajectories of 32 reflective markers placed on bony landmarks of participants. Three-dimensional kinematics of the whole body center of mass and base of support were computed. Results from the extrapolated center of mass displacement indicated that motor-cognitive training was more effective than the single-task motor training to improve dual-task balance performance (p=0.04, ES=0.11). Interestingly, balance performance under both single-task and dual-task conditions can also be improved through a non-motor, single-task cognitive training program (p=0.01, ES=0.13, and p=0.01, ES=0.11, respectively). However, improved dual-task processing skills during training were not transferred to the novel dual task (p=0.15, ES=0.09). This is the first study demonstrating that home-based dual-task training can be effectively implemented to improve balance performance during gait in older adults. Copyright © 2016 Elsevier B.V. All rights reserved.

Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study.

PubMed

Colón-Semenza, Cristina; Latham, Nancy K; Quintiliani, Lisa M; Ellis, Terry D

2018-02-15

Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were "satisfied" or "very satisfied" with the training program, and all participants were "satisfied" or "very satisfied" with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach. ©Cristina Colón-Semenza, Nancy K Latham, Lisa M Quintiliani, Terry D Ellis. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.02.2018.

Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study

PubMed Central

Latham, Nancy K; Quintiliani, Lisa M

2018-01-01

Background Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. Objective The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. Methods A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Results Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were “satisfied” or “very satisfied” with the training program, and all participants were “satisfied” or “very satisfied” with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Conclusions Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach. PMID:29449201

The influence of a constraint and bimanual training program using a variety of modalities on endurance and on the cardiac autonomic regulation system of children with unilateral cerebral palsy: A self-control clinical trial.

PubMed

Cohen-Holzer, Marilyn; Sorek, Gilad; Schweizer, Maayan; Katz-Leurer, Michal

2017-01-01

An intensive hybrid program, combining constraint with bimanual training, improves upper extremity function as well as walking endurance of children with unilateral cerebral palsy (UCP). Endurance improvement may be associated with the cardiac autonomic regulation system (CARS) adaptation, known to be impaired among these children. To examine the influence of an intensive hybrid program on CARS, walking endurance and the correlation with upper extremity function of children with UCP. Twenty-four children aged 6-10 years with UCP participated in a hybrid program, 10 days, 6 hours per day. Data were collected pre-, post- and 3-months post-intervention. Main outcome measures included the Polar RS800CX for heart rate (HR) and heart rate variability (HRV) data, the 6-Minute Walk Test (6MWT) for endurance, and the Assisting Hand Assessment (AHA) and Jebsen-Taylor Test of Hand Function (JTTHF) for bimanual and unimanual function. A significant reduction in HR and an increase in HRV at post- and 3-month post-intervention was noted (χ22= 8.3, p = 0.016) along with a significant increase in 6MWT with a median increase of 81 meters (χ22= 11.0, p = 0.004) at the same interval. A significant improvement was noted in unimanual and bimanual performance following the intervention. An intensive hybrid program effectively improved CARS function as well as walking endurance and upper extremity function in children with UCP (213).

Dose-Response Outcomes Associated with Different Forms of Locomotor Training in Persons with Chronic Motor-Incomplete Spinal Cord Injury.

PubMed

Sandler, Evan B; Roach, Kathryn E; Field-Fote, Edelle C

2017-05-15

Outcomes of training are thought to be related to the amount of training (training dose). Although various approaches to locomotor training have been used to improve walking function in persons with spinal cord injury (SCI), little is known about the relationship between dose of locomotor training and walking outcomes. This secondary analysis aimed to identify the relationship between training dose and improvement in walking distance and speed associated with locomotor training in participants with chronic motor-incomplete spinal cord injury (MISCI). We compared the dose-response relationships associated with each of four different locomotor training approaches. Participants were randomized to either: treadmill-based training with manual assistance (TM = 17), treadmill-based training with stimulation (TS = 18), overground training with stimulation (OG = 15), and treadmill-based training with locomotor robotic device assistance (LR = 14). Subjects trained 5 days/week for 12 weeks, with a target of 60 training sessions. The distance-dose and time-dose were calculated based on the total distance and total time, respectively, participants engaged in walking over all sessions combined. Primary outcome measures included walking distance (traversed in 2 min) and walking speed (over 10 m). Only OG training showed a good correlation between distance-dose and change in walking distance and speed walked over ground (r = 0.61, p = 0.02; r = 0.62, p = 0.01). None of the treadmill-based training approaches were associated with significant correlations between training dose and improvement of functional walking outcome. The findings suggest that greater distance achieved over the course of OG training is associated with better walking outcomes in the studied population. Further investigation to identify the essential elements that determine outcomes would be valuable for guiding rehabilitation.

Development of Training Programs to Optimize Planetary Ambulation

NASA Technical Reports Server (NTRS)

Bloomberg, J. J.; Mulavara, A. P.; Peters, B. T.; Cohen, H. S.; Miller, C. A.; Brady, R.; Warren, L. E.; Rutley, T. M.; Kozlovskaya, I. B.

2007-01-01

Astronauts experience disturbances in functional mobility following their return to Earth due to adaptive responses that occur during exposure to the microgravity conditions of space flight. Despite significant time spent performing in-flight exercise routines, these training programs have not been able to mitigate postflight alterations in postural and locomotor function. Therefore, the goal of our two inter-related projects (NSBRI-ground based and ISS flight study, "Mobility") is to develop and test gait training programs that will serve to optimize functional mobility during the adaptation period immediately following space flight, thereby improving the safety and efficiency of planetary ambulation. The gait training program entails manipulating the sensory conditions of treadmill exercise to systematically challenge the balance and gait control system. This enhances the overall adaptability of locomotor function enabling rapid reorganization of gait control to respond to ambulation in different gravitational environments. To develop the training program, we are conducting a series of ground-based studies evaluating the training efficacy associated with variation in visual flow, body loading, and support surface stability during treadmill walking. We will also determine the optimal method to present training stimuli within and across training sessions to maximize both the efficacy and efficiency of the training procedure. Results indicate that variations in both visual flow and body unloading during treadmill walking leads to modification in locomotor control and can be used as effective training modalities. Additionally, the composition and timing of sensory challenges experienced during each training session has significant impact on the ability to rapidly reorganize locomotor function when exposed to a novel sensory environment. We have developed the capability of producing support surface variation during gait training by mounting a treadmill on a six-degree-of-freedom motion device. This hardware development will allow us to evaluate the efficacy of this type of training in conjunction with variation in visual flow and body unloading.

[Effects of a resistance training program in patients with chronic kidney disease on hemodialysis].

PubMed

Cigarroa, Igor; Barriga, Rodrigo; Michéas, Camila; Zapata-Lamana, Rafael; Soto, Claudio; Manukian, Tomas

2016-07-01

Exercise may be a therapeutic tool for improving the functional capacity in patients with chronic kidney disease (CKD) who are on hemodialysis (HD). To determine the effects on muscle strength (MS), functional capacity (FC) and quality of life related to health (QOLRH) of a resistance training program in patients with CKD on HD. Thirteen CKD patients aged 38.8 ± 3 years, (7 men) on HD for more than one year participated in an exercise program twice a week during 8 weeks. At the beginning and at the end of the program, MS using a knee extension isometric strength test, FC using the six minutes walking test (6MWT) and QOLRH using the KDQOL CV-36 questionnaire were evaluated. Heart and respiratory rates, blood pressure, oxygen saturation and modified Borg scale were measured as control variables. After training, there were significant improvements in MS in both legs; in the distance travelled during 6MWT and in the physical component summary score of the KDQOL-36. Furthermore, a significant decline in diastolic blood pressure was observed. All other control variables did not change significantly. Exercise training during eight weeks in CKD patients in HD resulted in significant improvements in muscle strength, walking capacity and in the physical component of a quality of life score for patients with CKD.

Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

PubMed

Malagoni, Anna Maria; Vagnoni, Emidia; Felisatti, Michele; Mandini, Simona; Heidari, Mahdi; Mascoli, Francesco; Basaglia, Nino; Manfredini, Roberto; Zamboni, Paolo; Manfredini, Fabio

2011-01-01

Patients with intermittent claudication (IC) could benefit from low-cost, effective rehabilitative programs. This retrospective study evaluates compliance, impact on Quality of Life (QoL) and cost-effectiveness of a hospital prescribed, at-home performed (Test-in/Train-out) rehabilitative program for patients with IC. Two-hundred and eighty-nine patients with IC (71 ± 10.1 years, M = 210) were enrolled for a 2-year period. Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed, with serial check-ups at the hospital. Compliance with the program was assessed by assigning a score of 1 (lowest compliance) to 4 (highest compliance). The SF-36 questionnaire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance, respectively. Both direct and indirect costs of the program were considered for cost-effectiveness analysis. Two-hundred and fifty patients (70.5 ± 9.2 years, M = 191), at Fontaine's II-B stage (86%), were included in the study. No adverse events were reported. The average compliance score was 3.1. At discharge, both SF-36 domains and walking performance significantly increased (P < 0.0001). A total of 1,839 in-hospital check-ups (7.36 /patient) were performed. Direct and indirect costs represented 93% and 7% of the total costs, respectively. The average costs of a visit and of a therapy cycle were C68.93 and C507.20, respectively. The cost to walk an additional meter before stopping was C9.22. A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Comparison of the Effect of Lateral and Backward Walking Training on Walking Function in Patients with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial.

PubMed

Kim, Chang-Yong; Lee, Jung-Sun; Kim, Hyeong-Dong

2017-02-01

The purposes of the present study were to compare the effects of backward and lateral walking training and to identify whether additional backward or lateral walking training would be more effective in increasing the walking function of poststroke patients. Fifty-one subjects with hemiplegic stroke were randomly allocated to 3 groups, each containing 17 subjects: the control group, the backward walking training group, and the lateral walking training group. The walking abilities of each group were assessed using a 10-m walk test and the GAITRite system for spatiotemporal gait. The results show that there were significantly greater posttest increases in gait velocity (F = -12.09, P = 0.02) and stride length (F = -11.50, P = 0.02), decreases in the values of the 10-m walk test (F = -7.10, P = 0.03) (P < 0.05) and double-limb support period (F = 40.15, P = 0.000), and improvements in gait asymmetry (F = 13.88, P = 0.002) (P < 0.01) in subjects in the lateral walking training group compared with those in the other 2 groups. These findings demonstrate that asymmetric gait patterns in poststroke patients could be improved by receiving additional lateral walking training therapy rather than backward walking training. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) understand the potential benefits of backward walking (BW) and lateral walking (LW) training on improving muscle strength and gait; (2) appreciate the potential value of backward and lateral walking gait training in the treatment of hemiplegic stroke patients; and (3) appropriately incorporate backward and lateral walking gait training into the treatment plan of hemiplegic stroke patients. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial

PubMed Central

Duncan, Pamela W; Sullivan, Katherine J; Behrman, Andrea L; Azen, Stanley P; Wu, Samuel S; Nadeau, Stephen E; Dobkin, Bruce H; Rose, Dorian K; Tilson, Julie K

2007-01-01

Background Locomotor training using body weight support and a treadmill as a therapeutic modality for rehabilitation of walking post-stroke is being rapidly adopted into clinical practice. There is an urgent need for a well-designed trial to determine the effectiveness of this intervention. The objective of the Locomotor Experience Applied Post-Stroke (LEAPS) trial is to determine if there is a difference in the proportion of participants who recover walking ability at one year post-stroke when randomized to a specialized locomotor training program (LTP), conducted at 2- or 6-months post-stroke, or those randomized to a home based non-specific, low intensity exercise intervention (HEP) provided 2 months post-stroke. We will determine if the timing of LTP delivery affects gait speed at 1 year and whether initial impairment severity interacts with the timing of LTP. The effect of number of treatment sessions will be determined by changes in gait speed taken pre-treatment and post-12, -24, and -36 sessions. Methods/Design We will recruit 400 adults with moderate or severe walking limitations within 30 days of stroke onset. At two months post stroke, participants are stratified by locomotor impairment severity as determined by overground walking speed and randomly assigned to one of three groups: (a) LTP-Early; (b) LTP-Late or (c) Home Exercise Program -Early. The LTP program includes body weight support on a treadmill and overground training. The LTP and HEP interventions are delivered for 36 sessions over 12 weeks. Primary outcome measure include successful walking recovery defined as the achievement of a 0.4 m/s gait speed or greater by persons with initial severe gait impairment or the achievement of a 0.8 m/s gait speed or greater by persons with initial moderate gait impairment. LEAPS is powered to detect a 20% difference in the proportion of participants achieving successful locomotor recovery between the LTP groups and the HEP group, and a 0.1 m/s mean difference in gait speed change between the two LTP groups. Discussion The goal of this single-blinded, phase III randomized clinical trial is to provide evidence to guide post-stroke walking recovery programs. Trial registration NCT00243919. PMID:17996052

Effect of a combination of whole body vibration exercise and squat training on body balance, muscle power, and walking ability in the elderly.

PubMed

Osugi, Tomohiro; Iwamoto, Jun; Yamazaki, Michio; Takakuwa, Masayuki

2014-01-01

A randomized controlled trial was conducted to clarify the beneficial effect of whole body vibration (WBV) exercise plus squat training on body balance, muscle power, and walking ability in the elderly with knee osteoarthritis and/or spondylosis. Of 35 ambulatory patients (14 men and 21 women) who were recruited at our outpatient clinic, 28 (80.0%, 12 men and 16 women) participated in the trial. The subjects (mean age 72.4 years) were randomly divided into two groups (n=14 in each group), ie, a WBV exercise alone group and a WBV exercise plus squat training group. A 4-minute WBV exercise (frequency 20 Hz) was performed 2 days per week in both groups; squat training (20 times per minute) was added during the 4-minute WBV training session in the WBV exercise plus squat training group. The duration of the trial was 6 months. The exercise and training program was safe and well tolerated. WBV exercise alone improved indices of body balance and walking velocity from baseline values. However, WBV exercise plus squat training was more effective for improving tandem gait step number and chair-rising time compared with WBV exercise alone. These results suggest the benefit and safety of WBV exercise plus squat training for improving physical function in terms of body balance and muscle power in the elderly.

Whole-body vibration improves functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease (COPD): a pilot study

PubMed Central

Braz Júnior, Donato S; Dornelas de Andrade, Arméle; Teixeira, Andrei S; Cavalcanti, Cléssyo A; Morais, André B; Marinho, Patrícia EM

2015-01-01

Background Exercise intolerance is a common development in patients with chronic obstructive pulmonary disease (COPD). There is little data on the use of an isolated program using vibration platform training on functional capacity in these patients, which is an area that deserves investigation. Aim To investigate the effect of training on a vibrating platform (whole-body vibration [WBV]) on functional performance and quality of life of subjects with COPD. Methods A randomized controlled crossover pilot study with eleven subjects with COPD (forced expiratory volume in 1 second [FEV1]% predicted =14.63±11.14; forced vital capacity [FVC]% predicted =48.84±15.21; FEV1/FVC =47.39±11.63) underwent a 12-week WBV training program. Participants were randomized into the intervention group (IG) undergoing three sessions per week for a total of 12 weeks and control group (CG) without intervention. We evaluated the 6-minute walk test (6MWT), distance walked (DW), duration of the walk (TW), and index of perceived exertion (IPE), quality of life using St George’s Respiratory Questionnaire (SGRQ) and developed a 12-week program of training on a vibrating platform. Results The mean age was 62.91±8.82 years old (72.7% male). The DW increased at the end of training with a difference between groups of 75 m; all domains of the SGRQ improved at the end of training. The effect size Cohen’s d ranged from small to large for all the measured results. Conclusion These preliminary results suggest that WBV may potentially be a safe and feasible way to improve functional capacity in the 6MWT of patients with COPD undergoing a training program on the vibrating platform as well as in all domains of the SGRQ quality of life. However, further studies with a larger number of patients are needed to establish the long-term effect on functional capacity and quality of life in these patients. PMID:25624756

The feasibility and effectiveness of high-intensity boxing training versus moderate-intensity brisk walking in adults with abdominal obesity: a pilot study.

PubMed

Cheema, Birinder S; Davies, Timothy B; Stewart, Matthew; Papalia, Shona; Atlantis, Evan

2015-01-01

High-intensity interval training (HIIT) performed on exercise cycle or treadmill is considered safe and often more beneficial for fat loss and cardiometabolic health than moderate-intensity continuous training (MICT). The aim of this pilot study was to assess the feasibility and effectiveness of a 12-week boxing training (HIIT) intervention compared with an equivalent dose of brisk walking (MICT) in obese adults. Men and women with abdominal obesity and body mass index >25 kg/m(2) were randomized to either a boxing group or a brisk walking (control) group for 12 weeks. Each group engaged in 4 training sessions per week, equated for total physical activity. Feasibility outcomes included recruitment rates, assessment of training intensities, adherence and adverse events. Effectiveness was assessed pre and post intervention via pertinent obesity-, cardiovascular-, and health-related quality of life (HRQoL) outcomes. Nineteen individuals expressed an interest and 63% (n = 12) consented. Recruitment was slower than anticipated (1.3 participants/week). The boxing group trained at a significantly higher intensity each week versus the brisk walking group (p < 0.05). Two participants in the boxing group experienced an adverse event; both continued to exercise with modifications to the exercise program. No other adverse events were noted. The boxing group attended more sessions (79% vs. 55%) and had a lower attrition rate (n = 0 vs. n = 2) than the walking group. Analysis of covariance revealed that the boxing group significantly improved body fat percentage (p = 0.047), systolic blood pressure (p = 0.026), augmentation index (AIx; p < 0.001), absolute VO2max (p = 0.015), and Physical Functioning (p = 0.042) and Vitality (p = 0.024) domains of HRQoL over time. The walking group did not improve any clinical outcomes, and experienced a worsening of Vitality (p = 0.043). Boxing training (HIIT) in adults with abdominal obesity is feasible and may elicit a better therapeutic effect on obesity, cardiovascular, and HRQoL outcomes than an equivalent dose of brisk walking (MICT). Robustly designed randomized controlled trials are required to confirm these findings and inform clinical guidelines and practice for obesity treatment. ACTRN12615000007538.

Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury.

PubMed

Stevens, Sandra L; Caputo, Jennifer L; Fuller, Dana K; Morgan, Don W

2015-01-01

To document the effects of underwater treadmill training (UTT) on leg strength, balance, and walking performance in adults with incomplete spinal cord injury (iSCI). Pre-test and post-test design. Exercise physiology laboratory. Adult volunteers with iSCI (n = 11). Participants completed 8 weeks (3 × /week) of UTT. Each training session consisted of three walks performed at a personalized speed, with adequate rest between walks. Body weight support remained constant for each participant and ranged from 29 to 47% of land body weight. Increases in walking speed and duration were staggered and imposed in a gradual and systematic fashion. Lower-extremity strength (LS), balance (BL), preferred and rapid walking speeds (PWS and RWS), 6-minute walk distance (6MWD), and daily step activity (DSA). Significant (P < 0.05) increases were observed in LS (13.1 ± 3.1 to 20.6 ± 5.1 N·kg(-1)), BL (23 ± 11 to 32 ± 13), PWS (0.41 ± 0.27 to 0.55 ± 0.28 m·s(-1)), RWS (0.44 ± 0.31 to 0.71 ± 0.40 m·s(-1)), 6MWD (97 ± 80 to 177 ± 122 m), and DSA (593 ± 782 to 1310 ± 1258 steps) following UTT. Physical function and walking ability were improved in adults with iSCI following a structured program of UTT featuring individualized levels of body weight support and carefully staged increases in speed and duration. From a clinical perspective, these findings highlight the potential of UTT in persons with physical disabilities and diseases that would benefit from weight-supported exercise.

Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study.

PubMed

Escalona, Manuel J; Brosseau, Rachel; Vermette, Martin; Comtois, Alain Steve; Duclos, Cyril; Aubertin-Leheudre, Mylène; Gagnon, Dany H

2018-07-01

Many wheelchair users adopt a sedentary lifestyle, which results in progressive physical deconditioning with increased risk of musculoskeletal, cardiovascular and endocrine/metabolic morbidity and mortality. Engaging in a walking program with an overground robotic exoskeleton may be an effective strategy for mitigating these potential negative health consequences and optimizing fitness in this population. However, additional research is warranted to inform the development of adapted physical activity programs incorporating this technology. To determine cardiorespiratory demands during sitting, standing and overground walking with a robotic exoskeleton and to verify whether such overground walking results in at least moderate-intensity physical exercise. We enrolled 13 long-term wheelchair users with complete motor spinal cord injury in a walking program with an overground robotic exoskeleton. Cardiorespiratory measures and rate of perceived exertion (RPE) were recorded by using a portable gas analyzer system during sitting, standing and four 10m walking tasks with the robotic exoskeleton. Each participant also performed an arm crank ergometer test to determine maximal cardiorespiratory ability (i.e., peak heart rate and O 2 uptake [HR peak , VO 2peak ]). Cardiorespiratory measures increased by a range of 9%-35% from sitting to standing and further increased by 22%-52% from standing to walking with the robotic exoskeleton. During walking, median oxygen cost (O 2Walking ), relative HR (%HR peak ), relative O 2 consumption (%VO 2peak ) and respiratory exchange ratio (RER) reached 0.29mL/kg/m, 82.9%, 41.8% and 0.9, respectively, whereas median RPE reached 3.2/10. O 2Walking was moderately influenced by total number of sessions and steps taken with the robotic exoskeleton since the start of the walking program. Overground walking with the robotic exoskeleton over a short distance allowed wheelchair users to achieve a moderate-intensity level of exercise. Hence, an overground locomotor training program with a robotic exoskeleton may have cardiorespiratory health benefits in the population studied. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Does Nordic walking improves the postural control and gait parameters of women between the age 65 and 74: a randomized trial

PubMed Central

Kocur, Piotr; Wiernicka, Marzena; Wilski, Maciej; Kaminska, Ewa; Furmaniuk, Lech; Maslowska, Marta Flis; Lewandowski, Jacek

2015-01-01

[Purpose] To assess the effect of 12-weeks Nordic walking training on gait parameters and some elements of postural control. [Subjects and Methods] Sixty-seven women aged 65 to 74 years were enrolled in this study. The subjects were divided into a Nordic Walking group (12 weeks of Nordic walking training, 3 times a week for 75 minutes) and a control group. In both study groups, a set of functional tests were conducted at the beginning and at the end of the study: the Forward Reach Test (FRT) and the Upward Reach Test (URT) on a stabilometric platform, and the analysis of gait parameters on a treadmill. [Results] The NW group showed improvements in: the range of reach in the FRT test and the URT test in compared to the control group. The length of the gait cycle and gait cycle frequency also showed changes in the NW group compared to the control group. [Conclusion] A 12-week NW training program had a positive impact on selected gait parameters and may improve the postural control of women aged over 65 according to the results selected functional tests. PMID:26834341

Does Nordic walking improves the postural control and gait parameters of women between the age 65 and 74: a randomized trial.

PubMed

Kocur, Piotr; Wiernicka, Marzena; Wilski, Maciej; Kaminska, Ewa; Furmaniuk, Lech; Maslowska, Marta Flis; Lewandowski, Jacek

2015-12-01

[Purpose] To assess the effect of 12-weeks Nordic walking training on gait parameters and some elements of postural control. [Subjects and Methods] Sixty-seven women aged 65 to 74 years were enrolled in this study. The subjects were divided into a Nordic Walking group (12 weeks of Nordic walking training, 3 times a week for 75 minutes) and a control group. In both study groups, a set of functional tests were conducted at the beginning and at the end of the study: the Forward Reach Test (FRT) and the Upward Reach Test (URT) on a stabilometric platform, and the analysis of gait parameters on a treadmill. [Results] The NW group showed improvements in: the range of reach in the FRT test and the URT test in compared to the control group. The length of the gait cycle and gait cycle frequency also showed changes in the NW group compared to the control group. [Conclusion] A 12-week NW training program had a positive impact on selected gait parameters and may improve the postural control of women aged over 65 according to the results selected functional tests.

Developing Point-of-Decision Prompts to Encourage Airport Walking: The Walk to Fly Study.

PubMed

Frederick, Ginny M; Paul, Prabasaj; Bachtel Watson, Kathleen; Dorn, Joan M; Fulton, Janet

2016-04-01

Point-of-decision prompts may be appropriate to promote walking, instead of using a mechanized mode of transport, such as a train, in airports. To our knowledge, no current studies describe the development of messages for prompts in this setting. In-person interviews were conducted with 150 randomly selected airport travelers who rode the train to their departure gate. Travelers reported various reasons for riding the train to their gate. They were asked about messages that would encourage them to walk. Exploratory factor analysis was conducted for reasons for riding the train. Confirmatory factor analysis was conducted for messages to encourage walking to the departure gate. Travelers reported not knowing walking was an option (23.8%), seeing others riding the train (14.4%), and being afraid of getting lost (9.2%) as reasons for riding the train. Many indicated that directional signs and prompts promoting walking as exercise would encourage them to walk instead of riding the train. Some reasons for riding the train in an airport may be modifiable by installing point-of-decision prompts. Providing directional signs to travelers may prompt them to walk to their gate instead of riding the train. Similar prompts may also be considered in other community settings.

Developing Point-of-Decision Prompts to Encourage Airport Walking: The Walk to Fly Study

PubMed Central

Frederick, Ginny M.; Paul, Prabasaj; Watson, Kathleen Bachtel; Dorn, Joan M.; Fulton, Janet

2017-01-01

Background Point-of-decision prompts may be appropriate to promote walking, instead of using a mechanized mode of transport, such as a train, in airports. To our knowledge, no current studies describe the development of messages for prompts in this setting. Methods In-person interviews were conducted with 150 randomly selected airport travelers who rode the train to their departure gate. Travelers reported various reasons for riding the train to their gate. They were asked about messages that would encourage them to walk. Exploratory factor analysis was conducted for reasons for riding the train. Confirmatory factor analysis was conducted for messages to encourage walking to the departure gate. Results Travelers reported not knowing walking was an option (23.8%), seeing others riding the train (14.4%), and being afraid of getting lost (9.2%) as reasons for riding the train. Many indicated that directional signs and prompts promoting walking as exercise would encourage them to walk instead of riding the train. Conclusions Some reasons for riding the train in an airport may be modifiable by installing point-of-decision prompts. Providing directional signs to travelers may prompt them to walk to their gate instead of riding the train. Similar prompts may also be considered in other community settings. PMID:26445371

Effect of high-intensity home-based respiratory muscle training on strength of respiratory muscles following a stroke: a protocol for a randomized controlled trial.

PubMed

Menezes, Kênia Kiefer Parreiras De; Nascimento, Lucas Rodrigues; Polese, Janaine Cunha; Ada, Louise; Teixeira-Salmela, Luci Fuscaldi

Respiratory muscle training has shown to increase strength of the respiratory muscles following a stroke. However, low duration and/or intensity of training may be responsible for the small effect size seen and/or absence of carry-over effects to an activity, e.g., walking. Therefore, an investigation of the effects of long-duration, high-intensity respiratory muscle training is warranted. This proposed protocol for a randomized clinical trial will examine the efficacy of high-intensity respiratory muscle training to increase strength and improve activity following a stroke. This study will be a two-arm, prospectively registered, randomized controlled trial, with blinded assessors. Thirty-eight individuals who have suffered a stroke will participate. The experimental group will undertake a 40-min of respiratory muscle training program, seven days/week, for eight weeks in their homes. Training loads will be increased weekly. The control group will undertake a sham respiratory muscle training program with equivalent duration and scheduling of training. The primary outcome will be the strength of the inspiratory muscles, measured as maximal inspiratory pressure. Secondary outcomes will include expiratory muscle strength, inspiratory muscle endurance, dyspnea, respiratory complications, and walking capacity. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), after intervention (Week 8), and one month beyond intervention (Week 12). High-intensity respiratory muscle training may have the potential to optimize the strength of the respiratory muscles following a stroke. If benefits are carried over to activity, the findings may have broader implications, since walking capacity has been shown to predict physical activity and community participation on this population. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Is the ipsilateral cortex surrounding the lesion or the non-injured contralateral cortex important for motor recovery in rats with photochemically induced cortical lesions?

PubMed

Takata, Kotaro; Yamauchi, Hideki; Tatsuno, Hisashi; Hashimoto, Keiji; Abo, Masahiro

2006-01-01

To determine whether the ipsilateral cortex surrounding the lesion or the non-injured contralateral cortex is important for motor recovery after brain damage in the photochemically initiated thrombosis (PIT) model. We induced PIT in the sensorimotor cortex in rats and examined the recovery of motor function using the beam-walking test. In 24 rats, the right sensorimotor cortex was lesioned after 2 days of training for the beam-walking test (group 1). After 10 days, PIT was induced in the left sensorimotor cortex. Eight additional rats (group 2) received 2 days training in beam walking, then underwent the beam-walking test to evaluate function. After 10 days of testing, the left sensorimotor cortex was lesioned and recovery was monitored by the beam-walking test for 8 days. In group 1 animals, left hindlimb function caused by a right sensorimotor cortex lesion recovered within 10 days after the operation. Right hindlimb function caused by the left-side lesion recovered within 6 days. In group 2, right hindlimb function caused by induction of the left-side lesion after a total of 12 days of beam-walking training and testing recovered within 6 days as with the double PIT model. The training effect may be relevant to reorganization and neuromodulation. Motor recovery patterns did not indicate whether motor recovery was dependent on the ipsilateral cortex surrounding the lesion or the cortex of the contralateral side. The results emphasize the need for selection of appropriate programs tailored to the area of cortical damage in order to enhance motor functional recovery in this model. Copyright 2006 S. Karger AG, Basel.

Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial.

PubMed

Høyer, Ellen; Jahnsen, Reidun; Stanghelle, Johan Kvalvik; Strand, Liv Inger

2012-01-01

Treadmill training with body weight support (TTBWS) for relearning walking ability after brain damage is an approach under current investigation. Efficiency of this method beyond traditional training is lacking evidence, especially in patients needing walking assistance after stroke. The objective of this study was to investigate change in walking and transfer abilities, comparing TTBWS with traditional walking training. A single-blinded, randomized controlled trial was conducted. Sixty patients referred for multi-disciplinary primary rehabilitation were assigned into one of two intervention groups, one received 30 sessions of TTBWS plus traditional training, the other traditional training alone. Daily training was 1 hr. Outcome measures were Functional Ambulation Categories (FAC), Walking, Functional Independence Measure (FIM); shorter transfer and stairs, 10 m and 6-min walk tests. Substantial improvements in walking and transfer were shown within both groups after 5 and 11 weeks of intervention. Overall no statistical significant differences were found between the groups, but 12 of 17 physical measures tended to show improvements in favour of the treadmill approach. Both training strategies provided significant improvements in the tested activities, suggesting that similar outcomes can be obtained in the two modalities by systematic, intensive and goal directed training.

Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study.

PubMed

Chisholm, Amanda E; Malik, Raza Naseem; Blouin, Jean-Sébastien; Borisoff, Jaimie; Forwell, Susan; Lam, Tania

2014-06-06

Previous evidence suggests the effects of task-specific therapy can be further enhanced when sensory stimulation is combined with motor practice. Sensory tongue stimulation is thought to facilitate activation of regions in the brain that are important for balance and gait. Improvements in balance and gait have significant implications for functional mobility for people with incomplete spinal cord injury (iSCI). The aim of this case study was to evaluate the feasibility of a lab- and home-based program combining sensory tongue stimulation with balance and gait training on functional outcomes in people with iSCI. Two male participants (S1 and S2) with chronic motor iSCI completed 12 weeks of balance and gait training (3 lab and 2 home based sessions per week) combined with sensory tongue stimulation using the Portable Neuromodulation Stimulator (PoNS). Laboratory based training involved 20 minutes of standing balance with eyes closed and 30 minutes of body-weight support treadmill walking. Home based sessions consisted of balancing with eyes open and walking with parallel bars or a walker for up to 20 minutes each. Subjects continued daily at-home training for an additional 12 weeks as follow-up. Both subjects were able to complete a minimum of 83% of the training sessions. Standing balance with eyes closed increased from 0.2 to 4.0 minutes and 0.0 to 0.2 minutes for S1 and S2, respectively. Balance confidence also improved at follow-up after the home-based program. Over ground walking speed improved by 0.14 m/s for S1 and 0.07 m/s for S2, and skilled walking function improved by 60% and 21% for S1 and S2, respectively. Sensory tongue stimulation combined with task-specific training may be a feasible method for improving balance and gait in people with iSCI. Our findings warrant further controlled studies to determine the added benefits of sensory tongue stimulation to rehabilitation training.

The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial.

PubMed

Karstoft, Kristian; Winding, Kamilla; Knudsen, Sine H; Nielsen, Jens S; Thomsen, Carsten; Pedersen, Bente K; Solomon, Thomas P J

2013-02-01

To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness, body composition, and glycemic control. Subjects with type 2 diabetes were randomized to a control (n = 8), continuous-walking (n = 12), or interval-walking group (n = 12). Training groups were prescribed five sessions per week (60 min/session) and were controlled with an accelerometer and a heart-rate monitor. Continuous walkers performed all training at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: VO(2)max, body composition, and glycemic control (fasting glucose, HbA(1c), oral glucose tolerance test, and continuous glucose monitoring [CGM]). Training adherence was high (89 ± 4%), and training energy expenditure and mean intensity were comparable. VO(2)max increased 16.1 ± 3.7% in the interval-walking group (P < 0.05), whereas no changes were observed in the continuous-walking or control group. Body mass and adiposity (fat mass and visceral fat) decreased in the interval-walking group only (P < 0.05). Glycemic control (elevated mean CGM glucose levels and increased fasting insulin) worsened in the control group (P < 0.05), whereas mean (P = 0.05) and maximum (P < 0.05) CGM glucose levels decreased in the interval-walking group. The continuous walkers showed no changes in glycemic control. Free-living walking training is feasible in type 2 diabetic patients. Continuous walking offsets the deterioration in glycemia seen in the control group, and interval walking is superior to energy expenditure-matched continuous walking for improving physical fitness, body composition, and glycemic control.

Effects of Nordic walking training on exercise capacity and fitness in men participating in early, short-term inpatient cardiac rehabilitation after an acute coronary syndrome--a controlled trial.

PubMed

Kocur, Piotr; Deskur-Smielecka, Ewa; Wilk, Malgorzata; Dylewicz, Piotr

2009-11-01

To investigate the effects of Nordic Walking training supplemental to a standard, early rehabilitation programme on exercise capacity and physical fitness in men after an acute coronary syndrome. A controlled trial. Cardiac rehabilitation service of a provincial hospital. Eighty men 2-3 weeks after an acute coronary syndrome, with good exercise tolerance. Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group). Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test. Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 +/- 1.8 versus 9.2 +/- 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 +/- 1.5 versus 0.7 +/- 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group. Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.

Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy.

PubMed

Cho, Chunhee; Hwang, Wonjeong; Hwang, Sujin; Chung, Yijung

2016-03-01

Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy (CP). Virtual reality-based rehabilitation therapy is effective in motivating children with CP. This study investigated the effects of treadmill training with virtual reality on gait, balance, muscular strength, and gross motor function in children with CP. Eighteen children with spastic CP were randomly divided into the virtual reality treadmill training (VRTT) group (9 subjects, mean age, 10.2 years) and treadmill training (TT) group (9 subjects, mean age, 9.4 years). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. Muscle strength was assessed using a digitalized manual muscle tester. Gross motor function was assessed using the Gross Motor Functional Measure (GMFM). Balance was assessed using the Pediatric Balance Scale (PBS). Gait speed was assessed using the 10-meter walk test (10MWT), and gait endurance was assessed using the 2-minute walk test (2MWT). After training, gait and balance was improved in the VRTT compared to the TT group (P < 0.05). Muscular strength was significantly greater in the VRTT group than the TT group, except for right hamstring strength. The improvements in GMFM (standing) and PBS scores were greater in the VRTT group than the TT group (P < 0.05). Furthermore, the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group (P < 0.05). In conclusion, VRTT programs are effective for improving gait, balance, muscular strength, and gross motor function in children with CP.

The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs)

PubMed Central

2012-01-01

Background The implementation of evidence based clinical practice guidelines on self-management interventions to patients with chronic diseases is a complex process. A multifaceted strategy may offer an effective knowledge translation (KT) intervention to promote knowledge uptake and improve adherence in an effective walking program based on the Ottawa Panel Evidence Based Clinical Practice Guidelines among individuals with moderate osteoarthritis (OA). Methods A single-blind, randomized control trial was conducted. Patients with mild to moderate (OA) of the knee (n=222) were randomized to one of three KT groups: 1) Walking and Behavioural intervention (WB) (18 males, 57 females) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA; 2) Walking intervention (W) (24 males, 57 females) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet; 3) Self-directed control (C) (32 males, 52 females) wherein participants only received the educational pamphlet. One-way analyses of variance were used to test for differences in quality of life, adherence, confidence, and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period. Results Short-term program adherence was greater in WB compared to C (p<0.012) after 3 months. No statistical significance (p> 0.05) was observed for long-term adherence (6 to 12 months), and total adherence between the three groups. The three knowledge translation strategies demonstrated equivalent long-term results for the implementation of a walking program for older individuals with moderate OA. Lower dropout rates as well as higher retention rates were observed for WB at 12 and 18 months. Conclusion The additional knowledge translation behavioural component facilitated the implementation of clinical practice guidelines on walking over a short-term period. More studies are needed to improve the long-term walking adherence or longer guidelines uptake on walking among participants with OA. Particular attention should be taken into account related to patient’s characteristic and preference. OA can be managed through the implementation of a walking program based on clinical practice guidelines in existing community-based walking clubs as well as at home with the minimal support of an exercise therapist or a trained volunteer. Trial Registration Current Controlled Trials IRSCTNO9193542 PMID:23061875

Clinical experience using a 5-week treadmill training program with virtual reality to enhance gait in an ambulatory physical therapy service.

PubMed

Shema, Shirley Roth; Brozgol, Marina; Dorfman, Moran; Maidan, Inbal; Sharaby-Yeshayahu, Lior; Malik-Kozuch, Hila; Wachsler Yannai, Orly; Giladi, Nir; Hausdorff, Jeffrey M; Mirelman, Anat

2014-09-01

Current literature views safe gait as a complex task, relying on motor and cognitive resources. The use of virtual reality (VR) in gait training offers a multifactorial approach, showing positive effects on mobility, balance, and fall risk in elderly people and individuals with neurological disorders. This form of training has been described as a viable research tool; however, it has not been applied routinely in clinical practice. Recently, VR was used to develop an adjunct training method for use by physical therapists in an ambulatory clinical setting. The aim of this article is to describe the initial clinical experience of applying a 5-week VR clinical service to improve gait and mobility in people with a history of falls, poor mobility, or postural instability. A retrospective data analysis was conducted. The clinical records of the first 60 patients who completed the VR gait training program were examined. Training was provided 3 times per week for 5 weeks, with each session lasting approximately 1 hour and consisting of walking on a treadmill while negotiating virtual obstacles. Main outcome measures were compared across time and included the Timed "Up & Go" Test (TUG), the Two-Minute Walk Test (2MWT), and the Four Square Step Test (FSST). After 5 weeks of training, time to complete the TUG decreased by 10.3%, the distance walked during the 2MWT increased by 9.5%, and performance on the FSST improved by 13%. Limitations of the study include the use of a retrospective analysis with no control group and the lack of objective cognitive assessment. Treadmill training with VR appears to be an effective and practical tool that can be applied in an outpatient physical therapy clinic. This training apparently leads to improvements in gait, mobility, and postural control. It, perhaps, also may augment cognitive and functional aspects. © 2014 American Physical Therapy Association.

Aquatic Exercise Training is Effective in Maintaining Exercise Performance in Trained Heart Failure Patients: A Randomised Crossover Pilot Trial.

PubMed

Adsett, Julie; Morris, Norman; Kuys, Suzanne; Hwang, Rita; Mullins, Robert; Khatun, Mohsina; Paratz, Jennifer; Mudge, Alison

2017-06-01

Providing flexible models and a variety of exercise options are fundamental to supporting long-term exercise participation for patients with heart failure (HF). The aim of this pilot study was to determine the feasibility and efficacy of aquatic exercise training during a maintenance phase for a clinical heart failure population. In this 2 x 2 crossover design trial, individuals who had previously completed HF rehabilitation were randomised into either a land-based or aquatic training program once per week for six weeks, after which time they changed to the alternate exercise training protocol for an additional six weeks. Six-minute walk test (6MWT), grip strength, walk speed, and measures of balance were compared for the two training protocols. Fifty-one participants (43 males, mean age 69.2 yrs) contributed data for the analysis. Both groups maintained function during the follow-up period, however improvements in 6MWT were greater in the land-based training group (95% CI: 0.7, 22.5; p=0.038), by a mean difference of 10.8 metres. No significant difference was observed for other parameters when the two training protocols were compared. Attending an aquatic exercise program once per week is feasible for patients with stable HF and may provide a suitable option to maintain functional performance in select patients. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Effects of 12-week brisk walking training on exercise blood pressure in elderly patients with essential hypertension: a pilot study.

PubMed

He, L I; Wei, Wang Ren; Can, Zhao

2018-01-24

Essential hypertension (EP) is characterized by blood pressure (BP) elevations, which often lead to target organ damage and cardiovascular illness. The following study investigates whether aerobic exercise programs with different intensities could reduce the magnitude of BP rise. Patients with essential hypertension were recruited from the Baoshan Community Health Service Center. A total of 46 patients were finally selected and randomly assigned into two groups: control group (CON) included patients who did not participate in exercise intervention training; treatment group (TRG) included patients who participated in 12-week brisk walking training (60-min of brisk walking, three times a week for a total of 12 weeks). 3-minute step tests of low and high intensity were conducted pre- and post-intervention. To compare the effects of exercise intervention, 23 subjects with normal blood pressure (NBP) who did not participate in 12-week brisk walking training, were recruited. After 12 weeks of brisk walking, SBP of TRG during resting, low and high-intensity exercise was significantly reduced by 8.3mmHg, 15.6mmHg, and 22.6mmHg, respectively; while HR of TRG's during resting, low and high intensity was significantly reduced by 3.6beats/minute, 8.7beats/minute and 11.3beats/minute, respectively. Meanwhile, after 12 weeks of brisk walking, TRG's steps per day, [Formula: see text]o 2max , moderate physical activity time and physical activity energy expenditure significantly increased by 6000 steps, 2.4 ml/kg/m, 40 minutes and 113 kcal, respectively. At the same time, TRG's body fat rate and sedentary time significantly reduced by 2% and 60 minutes per day. Brisk walking can reduce the magnitude of BP rise during exercise of different intensities and may be reduced the risk of acute cardiovascular incidents in elderly patients with essential hypertension. EP: Essential hypertension; BP: blood pressure; CON: control group; TRG: treatment group; NBP: normal blood pressure; PA: physical activity.

Improvement of walking speed and gait symmetry in older patients after hip arthroplasty: a prospective cohort study.

PubMed

Rapp, Walter; Brauner, Torsten; Weber, Linda; Grau, Stefan; Mündermann, Annegret; Horstmann, Thomas

2015-10-12

Retraining walking in patients after hip or knee arthroplasty is an important component of rehabilitation especially in older persons whose social interactions are influenced by their level of mobility. The objective of this study was to test the effect of an intensive inpatient rehabilitation program on walking speed and gait symmetry in patients after hip arthroplasty (THA) using inertial sensor technology. Twenty-nine patients undergoing a 4-week inpatient rehabilitation program following THA and 30 age-matched healthy subjects participated in this study. Walking speed and gait symmetry parameters were measured using inertial sensor device for standardized walking trials (2*20.3 m in a gym) at their self-selected normal and fast walking speeds on postoperative days 15, 21, and 27 in patients and in a single session in control subjects. Walking speed was measured using timing lights. Gait symmetry was determined using autocorrelation calculation of the cranio-caudal (CC) acceleration signals from an inertial sensor placed at the lower spine. Walking speed and gait symmetry improved from postoperative days 15-27 (speed, female: 3.2 and 4.5 m/s; male: 4.2 and 5.2 m/s; autocorrelation, female: 0.77 and 0.81; male: 0.70 and 0.79; P <0.001 for all). After the 4-week rehabilitation program, walking speed and gait symmetry were still lower than those in control subjects (speed, female 4.5 m/s vs. 5.7 m/s; male: 5.2 m/s vs. 5.3 m/s; autocorrelation, female: 0.81 vs. 0.88; male: 0.79 vs. 0.90; P <0.001 for all). While patients with THA improved their walking capacity during a 4-week inpatient rehabilitation program, subsequent intensive gait training is warranted for achieving normal gait symmetry. Inertial sensor technology may be a useful tool for evaluating the rehabilitation process during the post-inpatient period.

Community-based walking exercise for peripheral artery disease: An exploratory pilot study

PubMed Central

Mays, Ryan J; Hiatt, William R; Casserly, Ivan P; Rogers, R Kevin; Main, Deborah S; Kohrt, Wendy M; Ho, P Michael; Regensteiner, Judith G

2016-01-01

Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease (PAD), but few exercise programs in community settings have been effective. The aim of this study was to determine the efficacy of a community-based walking exercise program with training, monitoring, and coaching (TMC) components to improve exercise performance and patient-reported outcomes in PAD patients. This was a randomized, controlled trial including PAD patients who previously received peripheral endovascular therapy or presented with stable claudication. Patients randomized (n=25) to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks. Patients in the control group did not receive treatment beyond standard advice to walk. The primary outcome in the intent-to-treat (ITT) analyses was peak walking time (PWT) on a graded treadmill. Secondary outcomes included claudication onset time (COT) and patient-reported outcomes assessed via the Walking Impairment Questionnaire (WIQ). Intervention group patients (n=10) did not significantly improve PWT when compared with the control group patients (n=10) (mean±standard error: +2.1±0.7 vs. 0.0±0.7 min, p=0.052). Changes in COT and WIQ scores were greater for intervention patients compared with control patients (COT: +1.6±0.8 vs. −0.6±0.7 min, p=0.045; WIQ: +18.3±4.2 vs. −4.6±4.2%, p=0.001). This pilot using a walking program with TMC and an ITT analyses did not improve the primary outcome in PAD patients. Other walking performance and patient self-reported outcomes were improved following exercise in community settings. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size. PMID:25755148

A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort.

PubMed

Kalron, Alon; Nitzani, Dalia; Magalashvili, David; Dolev, Mark; Menascu, Shay; Stern, Yael; Rosenblum, Uri; Pasitselsky, Diana; Frid, Lior; Zeilig, Gabi; Barmatz, Caroline; Givon, Uri; Achiron, Anat

2015-03-04

People with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability. Retrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center's 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient's specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups. All clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group. We presented comprehensive evidence verifying the effects of an intense goal-directed physical rehabilitation program on ambulation in people with multiple sclerosis presenting with different neurological impairment levels.

External Mechanical Work and Pendular Energy Transduction of Overground and Treadmill Walking in Adolescents with Unilateral Cerebral Palsy

PubMed Central

Zollinger, Marie; Degache, Francis; Currat, Gabriel; Pochon, Ludmila; Peyrot, Nicolas; Newman, Christopher J.; Malatesta, Davide

2016-01-01

Purpose: Motor impairments affect functional abilities and gait in children and adolescents with cerebral palsy (CP). Improving their walking is an essential objective of treatment, and the use of a treadmill for gait analysis and training could offer several advantages in adolescents with CP. However, there is a controversy regarding the similarity between treadmill and overground walking both for gait analysis and training in children and adolescents. The aim of this study was to compare the external mechanical work and pendular energy transduction of these two types of gait modalities at standard and preferred walking speeds in adolescents with unilateral cerebral palsy (UCP) and typically developing (TD) adolescents matched on age, height and body mass. Methods: Spatiotemporal parameters, external mechanical work and pendular energy transduction of walking were computed using two inertial sensors equipped with a triaxial accelerometer and gyroscope and compared in 10 UCP (14.2 ± 1.7 year) and 10 TD (14.1 ± 1.9 year) adolescents during treadmill and overground walking at standard and preferred speeds. Results: The treadmill induced almost identical mechanical changes to overground walking in TD adolescents and those with UCP, with the exception of potential and kinetic vertical and lateral mechanical works, which are both significantly increased in the overground-treadmill transition only in UCP (P < 0.05). Conclusions: Adolescents with UCP have a reduced adaptive capacity in absorbing and decelerating the speed created by a treadmill (i.e., dynamic stability) compared to TD adolescents. This may have an important implication in rehabilitation programs that assess and train gait by using a treadmill in adolescents with UCP. PMID:27148062

External Mechanical Work and Pendular Energy Transduction of Overground and Treadmill Walking in Adolescents with Unilateral Cerebral Palsy.

PubMed

Zollinger, Marie; Degache, Francis; Currat, Gabriel; Pochon, Ludmila; Peyrot, Nicolas; Newman, Christopher J; Malatesta, Davide

2016-01-01

Motor impairments affect functional abilities and gait in children and adolescents with cerebral palsy (CP). Improving their walking is an essential objective of treatment, and the use of a treadmill for gait analysis and training could offer several advantages in adolescents with CP. However, there is a controversy regarding the similarity between treadmill and overground walking both for gait analysis and training in children and adolescents. The aim of this study was to compare the external mechanical work and pendular energy transduction of these two types of gait modalities at standard and preferred walking speeds in adolescents with unilateral cerebral palsy (UCP) and typically developing (TD) adolescents matched on age, height and body mass. Spatiotemporal parameters, external mechanical work and pendular energy transduction of walking were computed using two inertial sensors equipped with a triaxial accelerometer and gyroscope and compared in 10 UCP (14.2 ± 1.7 year) and 10 TD (14.1 ± 1.9 year) adolescents during treadmill and overground walking at standard and preferred speeds. The treadmill induced almost identical mechanical changes to overground walking in TD adolescents and those with UCP, with the exception of potential and kinetic vertical and lateral mechanical works, which are both significantly increased in the overground-treadmill transition only in UCP (P < 0.05). Adolescents with UCP have a reduced adaptive capacity in absorbing and decelerating the speed created by a treadmill (i.e., dynamic stability) compared to TD adolescents. This may have an important implication in rehabilitation programs that assess and train gait by using a treadmill in adolescents with UCP.

Therapeutic effects of an anti-gravity treadmill (AlterG) training on gait and lower limbs kinematics and kinetics in children with cerebral palsy.

PubMed

Lotfian, M; Kharazi, M R; Mirbagheri, A; Dadashi, F; Nourian, R; Mirbagheri, M M

2017-07-01

We aimed to investigate the effects of the lower body weight support treadmill (AlterG) training on kinetics and kinematics of the lower extremities in children with cerebral palsy (CP). We provided a 45-minute training program, 3 times a week for 8 weeks. AlterG can support the subject's weight up to 70% so that the subject will be able to walk more comfortably to reach a more correct walking pattern. The kinematics and kinetics were evaluated using an isokinetic dynamometer. The locomotion parameters were assessed in the gait laboratory. Subjects performance was evaluated at four time points: baseline (prior to training), 1 and 2 months after the beginning of training, and one month after the end of the training (as a follow-up evaluation). The results showed that the major gait, kinematic, and kinetic parameters improved after the AlterG training and were persistent. These findings suggest that the AlterG training can be considered as a therapeutic tool for improving the lower limb performance and locomotion in children with CP.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis.

PubMed

Booth, Adam T C; Buizer, Annemieke I; Meyns, Pieter; Oude Lansink, Irene L B; Steenbrink, Frans; van der Krogt, Marjolein M

2018-03-07

The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP). The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability. Forty-one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait-related gross motor function. There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects. Functional gait training is a safe, feasible, and effective intervention to improve walking ability. Functional gait training shows larger positive effects on walking speed than standard physical therapy. Walking endurance and gait-related gross motor function can also benefit from functional gait training. Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes. © 2018 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Walking on an Oscillating Treadmill: Two Paths to Functional Adaptation

NASA Technical Reports Server (NTRS)

Brady, Rachel A.; Peters, Brian T.; Bloomberg, Jacob J.

2010-01-01

We mounted a treadmill on top of a six degree-of-freedom motion base platform to investigate and characterize locomotor responses produced by healthy adults when introduced to a novel walking condition. Subjects were classified into two groups according to how their stride times were affected by the perturbation. Our data suggest that a person's choice of adaptation strategy is influenced by the relationship between his unique, natural stride frequency and the external frequency imposed by the motion base. Our data suggest that a person's stride time response while walking on a laterally oscillating treadmill is influenced by the relationship between his unique, natural stride frequency and the imposed external frequency of the motion base. This relationship may be useful for checking the efficacy of gait training and rehabilitation programs. Preselecting and manipulating a person's EST could be one way to draw him out of his preferred "entrainment well" during therapy or training.

Enhancing astronaut performance using sensorimotor adaptability training

PubMed Central

Bloomberg, Jacob J.; Peters, Brian T.; Cohen, Helen S.; Mulavara, Ajitkumar P.

2015-01-01

Astronauts experience disturbances in balance and gait function when they return to Earth. The highly plastic human brain enables individuals to modify their behavior to match the prevailing environment. Subjects participating in specially designed variable sensory challenge training programs can enhance their ability to rapidly adapt to novel sensory situations. This is useful in our application because we aim to train astronauts to rapidly formulate effective strategies to cope with the balance and locomotor challenges associated with new gravitational environments—enhancing their ability to “learn to learn.” We do this by coupling various combinations of sensorimotor challenges with treadmill walking. A unique training system has been developed that is comprised of a treadmill mounted on a motion base to produce movement of the support surface during walking. This system provides challenges to gait stability. Additional sensory variation and challenge are imposed with a virtual visual scene that presents subjects with various combinations of discordant visual information during treadmill walking. This experience allows them to practice resolving challenging and conflicting novel sensory information to improve their ability to adapt rapidly. Information obtained from this work will inform the design of the next generation of sensorimotor countermeasures for astronauts. PMID:26441561

Enhancing astronaut performance using sensorimotor adaptability training.

PubMed

Bloomberg, Jacob J; Peters, Brian T; Cohen, Helen S; Mulavara, Ajitkumar P

2015-01-01

Astronauts experience disturbances in balance and gait function when they return to Earth. The highly plastic human brain enables individuals to modify their behavior to match the prevailing environment. Subjects participating in specially designed variable sensory challenge training programs can enhance their ability to rapidly adapt to novel sensory situations. This is useful in our application because we aim to train astronauts to rapidly formulate effective strategies to cope with the balance and locomotor challenges associated with new gravitational environments-enhancing their ability to "learn to learn." We do this by coupling various combinations of sensorimotor challenges with treadmill walking. A unique training system has been developed that is comprised of a treadmill mounted on a motion base to produce movement of the support surface during walking. This system provides challenges to gait stability. Additional sensory variation and challenge are imposed with a virtual visual scene that presents subjects with various combinations of discordant visual information during treadmill walking. This experience allows them to practice resolving challenging and conflicting novel sensory information to improve their ability to adapt rapidly. Information obtained from this work will inform the design of the next generation of sensorimotor countermeasures for astronauts.

Effects of a sitting boxing program on upper limb function, balance, gait, and quality of life in stroke patients.

PubMed

Park, Junhyuck; Gong, Jihwan; Yim, Jongeun

2017-01-01

Boxing training including traditional stretching, muscular strength training, and duration training would be considered to be effective for improved functional stretching, dynamic balance, walking speed, and quality of life. We aimed to investigate upper limb function, balance, gait, and quality of life in stroke patients before and after a sitting boxing program. Twenty-six participants were randomly allocated to a boxing group (n = 13) and control group (n = 13) after the upper limb function, balance, gait, and quality of Life were recorded. The boxing group underwent a sitting boxing program (3 times/week) as well as conventional physical therapy (3 times/week) for 6 weeks. The control group only underwent conventional physical therapy (3 times/week) for 6 weeks. The Manual Functional Test (MFT), non-affected hand grip, Berg Balance Scale (BBS), velocity moment with eye opened, 10-m Walk Test (10 MWT), and Stroke-Specific Quality of Life questionnaire (SS-QOL) were significantly improved in the boxing group (p < 0.05) and showed significantly greater improvements in the boxing group compared to the control group (p < 0.05) after 6 weeks. The sitting boxing program group had positive effects on upper extremity function, balance, gait, and quality of life in stroke patients.

Dance Is Not a Dirty Word

ERIC Educational Resources Information Center

Goodwin, Brenda

2010-01-01

Successful physical educators should always search for fun and effective ways to keep their students fit and active. According to Garber, McKinney, and Carleton (1992), an aerobic dance program can be "an effective alternative to a traditional walk-jog training regime." Such a program can provide students with a unique, creative, and worthwhile…

The impact of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with cerebral palsy.

PubMed

Azizi, Sh; Marzbani, H; Raminfard, S; Birgani, P M; Rasooli, A H; Mirbagheri, M M

2017-07-01

We studied the effects of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with Cerebral Palsy (CP). AlterG can help CP children walk on the treadmill by reducing their weights up to 80% and maintain their balance during locomotion. AlterG training thus has the potential to improve walking capacity permanently as it can provide systematic and intense locomotor training for sufficiently long period of time and produce brain neuroplasticity. AlterG training was given for 45 minutes, three times a week for two months. The neuroplasticity of corticospinal tract was evaluated using Diffusion Tensor Imaging (DTI). The fractional Anisotropy (FA) feature was extracted to quantify structural changes of the corticospinal tract. Walking capacity was evaluated using popular clinical measurements of gait; i.e., walking speed, mobility and balance. The evaluations were done before and after training. Our results revealed that AlterG training resulted in an increase in average FA value of the corticospinal tract following the training. The outcome measures of clinical assessments of gait presented enhanced walking capacity of the CP subjects. Our findings indicated that the improved walking capacity was concurrent with the enhancement of the corticospinal tract structure. The clinical implication is that AlterG training may be considered as a therapeutic tool for permanent gait improvement in CP children.

Effects of intensive therapy using gait trainer or floor walking exercises early after stroke.

PubMed

Peurala, Sinikka H; Airaksinen, Olavi; Huuskonen, Pirjo; Jäkälä, Pekka; Juhakoski, Mika; Sandell, Kaisa; Tarkka, Ina M; Sivenius, Juhani

2009-02-01

To analyse the effects of gait therapy for patients after acute stroke in a randomized controlled trial. Fifty-six patients with a mean of 8 days post-stroke participated in: (i) gait trainer exercise; (ii) walking training over ground; or (iii) conventional treatment. Patients in the gait trainer exercise and walking groups practiced gait for 15 sessions over 3 weeks and received additional physiotherapy. Functional Ambulatory Category and several secondary outcome measures assessing gait and mobility were administered before and after rehabilitation and at 6-month follow-up. Patients also evaluated their own effort. Walking ability improved more with intensive walk training compared with conventional treatment; median Functional Ambulatory Category was zero in all patients at the start of the study, but it was 3 in both walk-training groups and 0.5 in the conventional treatment group at the end of the therapy. Median Functional Ambulatory Category was 4 in both walk-training groups and 2.5 in conventional treatment group at 6-month follow-up. Mean accomplished walking distance was not different between the gait trainer exercise and over ground walking groups. Borg scale indicated more effort in over ground walking. Secondary outcomes also indicated improvements. Exercise therapy with walking training improved gait function irrespective of the method used, but the time and effort required to achieve the results favour the gait trainer exercise. Early intensive gait training resulted in better walking ability than did conventional treatment.

Neuromuscular Electrical Stimulation Versus Volitional Isometric Strength Training in Children With Spastic Diplegic Cerebral Palsy: A Preliminary Study

PubMed Central

Stackhouse, Scott K.; Binder-Macleod, Stuart A.; Stackhouse, Carrie A.; McCarthy, James J.; Prosser, Laura A.; Lee, Samuel C. K.

2011-01-01

Background To date, no reports have investigated neuromuscular electrical stimulation (NMES) to increase muscle force production of children with cerebral palsy (CP) using high-force contractions and low repetitions. Objective The aims of this study were to determine if isometric NMES or volitional training in children with CP could increase muscle strength and walking speed and to examine the mechanisms that may contribute to increased force production. Methods Eleven children with spastic diplegia were assigned to an NMES training group or to a volitional training group. Participants in the NMES group had electrodes implanted percutaneously to activate the quadriceps femoris and triceps surae muscles. The volitional group trained with maximal effort contractions. Both groups performed a 12-week isometric strength-training program. Maximum voluntary isometric contract ion (MVIC) force, voluntary muscle activation, quadriceps and triceps surae cross-sectional area (CSA), and walking speed were measured pre- and post-strength training. Results The NMES-trained group had greater increases in normalized force production for both die quadriceps femoris and triceps surae. Similarly only the NMES group showed an increase in walking speed after training. Changes in voluntary muscle activation explained approximately 67% and 37% of the changes seen in the MVIC of the NMES and volitional groups, respectively. Quadriceps femoris maximum CSA increased significantly for the NMES group only. Conclusions This study was the first to quantitatively show strength gains with the use of NMES in children with CP. These results support the need for future experimental studies that will examine the clinical effectiveness of NMES strength training. PMID:17369515

Translation of a Motor Learning Walking Rehabilitation Program Into a Group-Based Exercise Program for Community-Dwelling Older Adults.

PubMed

Brach, Jennifer S; Francois, Sara J; VanSwearingen, Jessie M; Gilmore, Sandra; Perera, Subashan; Studenski, Stephanie A

2016-06-01

Traditional exercise programs for older adults, which focus on aerobic and strength training, have had only modest effects on walking. Recently, a motor learning exercise program was shown to have greater effects on walking compared with a traditional exercise program. Translating this novel motor learning exercise program into a group exercise program would allow it to be offered as an evidence-based, community-based program for older adults. To translate a walking rehabilitation program based on motor learning theory from one-on-one to group delivery (On the Move) and evaluate multiple aspects of implementation in older adults with impaired mobility. The translation process involved multiple iterations, including meetings of experts in the field (Phase I), focus groups (Phase II), and implementation of the newly developed program (Phase III). Phase III was based on a one-group model of intervention development for feasibility, safety, potential effects, and acceptability. Community sites, including 2 independent living facilities, an apartment building, and a community center. Adults 65 years of age or older who could ambulate independently and who were medically stable. Thirty-one adults, mean age 82.3 ± 5.6 years, were eligible to participate. The group exercise program was held twice a week for 12 weeks. Acceptability of the program was determined by retention and adherence rates and a satisfaction survey. Risk was measured by adverse events and questions on perceived challenge and safety. Mobility was assessed pre- and postintervention by gait speed, Figure of 8 Walk Test, and 6-minute walk test. Modifications to the program included adjustments to format/length, music, education, and group interaction. The 12-week program was completed by 24 of 31 entrants (77%). Adherence was high, with participants attending on average 83% of the classes. Safety was excellent, with only 1 subject experiencing a controlled, noninjurious fall. There was preliminary evidence for improved mobility after the intervention: gait speed improved from 0.76 ± 0.21 to 0.81 ± 0.22 m/s, P = .06; Figure of 8 Walk Test from 13.0 ± 3.9 to 12.0 ± 3.9 seconds, P = .07; and 6-minute walk test from 246 ± 75 to 281 ± 67 m, P = .02. The group-based program was safe and acceptable to older adults with impaired mobility and resulted in potentially clinically meaningful improvements in mobility. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Effect of aquatic versus land based exercise programs on physical performance in severely burned patients: a randomized controlled trial.

PubMed

Zoheiry, Ibrahim M; Ashem, Haidy N; Ahmed, Hamada Ahmed Hamada; Abbas, Rami

2017-12-01

[Purpose] To compare the effect of an aquatic-based versus a land-based exercise regimen on the physical performance of severely burned patients. [Subjects and Methods] Forty patients suffering from severe burn (total body surface area more than 30%) were recruited from several outpatient clinics in Greater Cairo. Their ages ranged between 20 to 40 years and were randomly assigned into two equal groups: group (A), which received an aquatic based exercise program, and group (B), which received a land-based exercise program. The exercise program, which took place in 12 consecutive weeks, consisted of flexibility, endurance, and lower and upper body training. Physical performance was assessed using 30 seconds chair stand test, stair climb test, 30 meter fast paced walk test, time up and go test, 6-minute walk test and a VO2max evaluation. [Results] Significantly increase in the 30 second chair stand, 6-minute walk, 30 meter fast paced walk, stair climb, and VO2 max tests and significantly decrease in the time up and go test in group A (aquatic based exercise) compared with group B (a land-based exercise) at the post treatment. [Conclusion] Twelve-week program of an aquatic program yields improvement in both physical performance and VO2 max in patients with severe burns.

Effect of aquatic versus land based exercise programs on physical performance in severely burned patients: a randomized controlled trial

PubMed Central

Zoheiry, Ibrahim M.; Ashem, Haidy N.; Ahmed, Hamada Ahmed Hamada; Abbas, Rami

2017-01-01

[Purpose] To compare the effect of an aquatic-based versus a land-based exercise regimen on the physical performance of severely burned patients. [Subjects and Methods] Forty patients suffering from severe burn (total body surface area more than 30%) were recruited from several outpatient clinics in Greater Cairo. Their ages ranged between 20 to 40 years and were randomly assigned into two equal groups: group (A), which received an aquatic based exercise program, and group (B), which received a land-based exercise program. The exercise program, which took place in 12 consecutive weeks, consisted of flexibility, endurance, and lower and upper body training. Physical performance was assessed using 30 seconds chair stand test, stair climb test, 30 meter fast paced walk test, time up and go test, 6-minute walk test and a VO2max evaluation. [Results] Significantly increase in the 30 second chair stand, 6-minute walk, 30 meter fast paced walk, stair climb, and VO2 max tests and significantly decrease in the time up and go test in group A (aquatic based exercise) compared with group B (a land-based exercise) at the post treatment. [Conclusion] Twelve-week program of an aquatic program yields improvement in both physical performance and VO2 max in patients with severe burns. PMID:29643605

Treadmill training and body weight support for walking after stroke.

PubMed

Mehrholz, Jan; Pohl, Marcus; Elsner, Bernhard

2014-01-23

Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane review first published in 2005. To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. We searched the Cochrane Stroke Group Trials Register (last searched June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (The Cochrane Library 2013, Issue 7), MEDLINE (1966 to July 2013), EMBASE (1980 to July 2013), CINAHL (1982 to June 2013), AMED (1985 to July 2013) and SPORTDiscus (1949 to June 2013). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists and contacted trialists to identify further trials. Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. Two authors independently selected trials, extracted data and assessed methodological quality. The primary outcomes investigated were walking speed, endurance and dependency. We included 44 trials with 2658 participants in this updated review. Overall, the use of treadmill training with body weight support did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; P = 0.94; I² = 0%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.07 m/s (95% CI 0.01 to 0.12; P = 0.02; I² = 57%) and the pooled MD for walking endurance was 26.35 metres (95% CI 2.51 to 50.19; P = 0.03; I² = 60%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up significantly. The pooled MD (random-effects model) for walking velocity was 0.04 m/s (95% CI -0.06 to 0.14; P = 0.40; I² = 40%) and the pooled MD for walking endurance was 32.36 metres (95% CI -3.10 to 67.81; P = 0.07; I² = 63%). However, for ambulatory patients improvements in walking endurance lasted until the end of scheduled follow-up (MD 58.88 metres, 95% CI 29.10 to 88.66; P = 0.0001; I² = 0%). Adverse events and drop outs did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. Overall, people after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve. Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to benefit most from this type of intervention. This review found that improvements in walking endurance in people able to walk may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory patients, but not in dependent walkers.

Variety Wins: Soccer-Playing Robots and Infant Walking.

PubMed

Ossmy, Ori; Hoch, Justine E; MacAlpine, Patrick; Hasan, Shohan; Stone, Peter; Adolph, Karen E

2018-01-01

Although both infancy and artificial intelligence (AI) researchers are interested in developing systems that produce adaptive, functional behavior, the two disciplines rarely capitalize on their complementary expertise. Here, we used soccer-playing robots to test a central question about the development of infant walking. During natural activity, infants' locomotor paths are immensely varied. They walk along curved, multi-directional paths with frequent starts and stops. Is the variability observed in spontaneous infant walking a "feature" or a "bug?" In other words, is variability beneficial for functional walking performance? To address this question, we trained soccer-playing robots on walking paths generated by infants during free play and tested them in simulated games of "RoboCup." In Tournament 1, we compared the functional performance of a simulated robot soccer team trained on infants' natural paths with teams trained on less varied, geometric paths-straight lines, circles, and squares. Across 1,000 head-to-head simulated soccer matches, the infant-trained team consistently beat all teams trained with less varied walking paths. In Tournament 2, we compared teams trained on different clusters of infant walking paths. The team trained with the most varied combination of path shape, step direction, number of steps, and number of starts and stops outperformed teams trained with less varied paths. This evidence indicates that variety is a crucial feature supporting functional walking performance. More generally, we propose that robotics provides a fruitful avenue for testing hypotheses about infant development; reciprocally, observations of infant behavior may inform research on artificial intelligence.

Ongoing Walking Recovery 2 Years After Locomotor Training in a Child With Severe Incomplete Spinal Cord Injury

PubMed Central

Fox, Emily J.; Tester, Nicole J.; Phadke, Chetan P.; Nair, Preeti M.; Senesac, Claudia R.; Howland, Dena R.

2010-01-01

Background and Purpose The authors previously reported on walking recovery in a nonambulatory child with chronic, severe, incomplete cervical spinal cord injury (SCI) after 76 sessions of locomotor training (LT). Although clinical measures did not predict his recovery, reciprocal patterned leg movements developed, affording recovery of independent walking with a reverse rolling walker. The long-term functional limitations and secondary complications often associated with pediatric-onset SCI necessitate continued follow-up of children with SCI. Therefore, the purpose of this case report is to describe this child's walking function and musculoskeletal growth and development during the 2 years since his participation in an LT program and subsequent walking recovery. Case Description Following LT, the child attended elementary school as a full-time ambulator. He was evaluated 1 month (baseline), 1 year, and 2 years after LT. Examination of walking function included measures of walking independence, gait speed and spatiotemporal parameters, gait kinematics, and daily step activity. Growth and development were assessed by tracking his height, weight, incidence of musculoskeletal complications, and gross motor task performance. Outcomes Over the 2 years, the child continued to ambulate independently with a reverse rolling walker, increasing his fastest gait speed. Spatiotemporal and kinematic features of his walking improved, and daily step activity increased. Height and weight remained on their preinjury trajectory and within age-appropriate norms. The child experienced only minor musculoskeletal complications. Additionally, he gained the ability to use reciprocal patterned leg movements during locomotor tasks such as assisted stair climbing and independent tricycle pedaling. Conclusions Two years after recovery of walking, this child with incomplete SCI had maintained and improved his walking function and experienced age-appropriate growth and development. PMID:20299409

Ongoing walking recovery 2 years after locomotor training in a child with severe incomplete spinal cord injury.

PubMed

Fox, Emily J; Tester, Nicole J; Phadke, Chetan P; Nair, Preeti M; Senesac, Claudia R; Howland, Dena R; Behrman, Andrea L

2010-05-01

The authors previously reported on walking recovery in a nonambulatory child with chronic, severe, incomplete cervical spinal cord injury (SCI) after 76 sessions of locomotor training (LT). Although clinical measures did not predict his recovery, reciprocal patterned leg movements developed, affording recovery of independent walking with a reverse rolling walker. The long-term functional limitations and secondary complications often associated with pediatric-onset SCI necessitate continued follow-up of children with SCI. Therefore, the purpose of this case report is to describe this child's walking function and musculoskeletal growth and development during the 2 years since his participation in an LT program and subsequent walking recovery. Following LT, the child attended elementary school as a full-time ambulator. He was evaluated 1 month (baseline), 1 year, and 2 years after LT. Examination of walking function included measures of walking independence, gait speed and spatiotemporal parameters, gait kinematics, and daily step activity. Growth and development were assessed by tracking his height, weight, incidence of musculoskeletal complications, and gross motor task performance. Over the 2 years, the child continued to ambulate independently with a reverse rolling walker, increasing his fastest gait speed. Spatiotemporal and kinematic features of his walking improved, and daily step activity increased. Height and weight remained on their preinjury trajectory and within age-appropriate norms. The child experienced only minor musculoskeletal complications. Additionally, he gained the ability to use reciprocal patterned leg movements during locomotor tasks such as assisted stair climbing and independent tricycle pedaling. Two years after recovery of walking, this child with incomplete SCI had maintained and improved his walking function and experienced age-appropriate growth and development.

Effects of an Off-Axis Pivoting Elliptical Training Program on Gait Function in Persons With Spastic Cerebral Palsy: A Preliminary Study.

PubMed

Tsai, Liang-Ching; Ren, Yupeng; Gaebler-Spira, Deborah J; Revivo, Gadi A; Zhang, Li-Qun

2017-07-01

This preliminary study examined the effects of off-axis elliptical training on reducing transverse-plane gait deviations and improving gait function in 8 individuals with cerebral palsy (CP) (15.5 ± 4.1 years) who completed an training program using a custom-made elliptical trainer that allows transverse-plane pivoting of the footplates during exercise. Lower-extremity off-axis control during elliptical exercise was evaluated by quantifying the root-mean-square and maximal angular displacement of the footplate pivoting angle. Lower-extremity pivoting strength was assessed. Gait function and balance were evaluated using 10-m walk test, 6-minute-walk test, and Pediatric Balance Scale. Toe-in angles during gait were quantified. Participants with CP demonstrated a significant decrease in the pivoting angle (root mean square and maximal angular displacement; effect size, 1.00-2.00) and increase in the lower-extremity pivoting strength (effect size = 0.91-1.09) after training. Reduced 10-m walk test time (11.9 ± 3.7 seconds vs. 10.8 ± 3.0 seconds; P = 0.004; effect size = 1.46), increased Pediatric Balance Scale score (43.6 ± 12.9 vs. 45.6 ± 10.8; P = 0.042; effect size = 0.79), and decreased toe-in angle (3.7 ± 10.5 degrees vs. 0.7 ± 11.7 degrees; P = 0.011; effect size = 1.22) were observed after training. We present an intervention to challenge lower-extremity off-axis control during a weight-bearing and functional activity for individuals with CP. Our preliminary findings suggest that this intervention was effective in enhancing off-axis control, gait function, and balance and reducing in-toeing gait in persons with CP.

Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review.

PubMed

Mehrholz, J; Harvey, L A; Thomas, S; Elsner, B

2017-08-01

Systematic review about randomised trials comparing different training strategies to improve gait in people with spinal cord injuries (SCI). The aim of this systematic review was to compare the effectiveness of body-weight-supported treadmill training (BWSTT) and robotic-assisted gait training with overground gait training and other forms of physiotherapy in people with traumatic SCI. Systematic review conducted by researchers from Germany and Australia. An extensive search was conducted for randomised controlled trials involving people with traumatic SCI that compared either BWSTT or robotic-assisted gait training with overground gait training and other forms of physiotherapy. The two outcomes of interest were walking speed (m s -1 ) and walking distance (m). BWSTT and robotic-assisted gait training were analysed separately, and data were pooled across trials to derive mean between-group differences using a random-effects model. Thirteen randomised controlled trials involving 586 people were identified. Ten trials involving 462 participants compared BWSTT to overground gait training and other forms of physiotherapy, but only nine trials provided useable data. The pooled mean (95% confidence interval (CI)) between-group differences for walking speed and walking distance were -0.03 m s -1 (-0.10 to 0.04) and -7 m (-45 to 31), respectively, favouring overground gait training. Five trials involving 344 participants compared robotic-assisted gait training to overground gait training and other forms of physiotherapy but only three provided useable data. The pooled mean (95% CI) between-group differences for walking speed and walking distance were -0.04 m s -1 (95% CI -0.21 to 0.13) and -6 m (95% CI -86 to 74), respectively, favouring overground gait training. BWSTT and robotic-assisted gait training do not increase walking speed more than overground gait training and other forms of physiotherapy do, but their effects on walking distance are not clear.

Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury

PubMed Central

Stevens, Sandra L.; Caputo, Jennifer L.; Fuller, Dana K.; Morgan, Don W.

2015-01-01

Objective To document the effects of underwater treadmill training (UTT) on leg strength, balance, and walking performance in adults with incomplete spinal cord injury (iSCI). Design Pre-test and post-test design. Setting Exercise physiology laboratory. Participants Adult volunteers with iSCI (n = 11). Intervention Participants completed 8 weeks (3 × /week) of UTT. Each training session consisted of three walks performed at a personalized speed, with adequate rest between walks. Body weight support remained constant for each participant and ranged from 29 to 47% of land body weight. Increases in walking speed and duration were staggered and imposed in a gradual and systematic fashion. Outcome measures Lower-extremity strength (LS), balance (BL), preferred and rapid walking speeds (PWS and RWS), 6-minute walk distance (6MWD), and daily step activity (DSA). Results Significant (P < 0.05) increases were observed in LS (13.1 ± 3.1 to 20.6 ± 5.1 N·kg−1), BL (23 ± 11 to 32 ± 13), PWS (0.41 ± 0.27 to 0.55 ± 0.28 m·s−1), RWS (0.44 ± 0.31 to 0.71 ± 0.40 m·s−1), 6MWD (97 ± 80 to 177 ± 122 m), and DSA (593 ± 782 to 1310 ± 1258 steps) following UTT. Conclusion Physical function and walking ability were improved in adults with iSCI following a structured program of UTT featuring individualized levels of body weight support and carefully staged increases in speed and duration. From a clinical perspective, these findings highlight the potential of UTT in persons with physical disabilities and diseases that would benefit from weight-supported exercise. PMID:24969269

Exercise volume and intensity: a dose-response relationship with health benefits.

PubMed

Foulds, Heather J A; Bredin, Shannon S D; Charlesworth, Sarah A; Ivey, Adam C; Warburton, Darren E R

2014-08-01

The health benefits of exercise are well established. However, the relationship between exercise volume and intensity and health benefits remains unclear, particularly the benefits of low-volume and intensity exercise. The primary purpose of this investigation was, therefore, to examine the dose-response relationship between exercise volume and intensity with derived health benefits including volumes and intensity of activity well below international recommendations. Generally healthy, active participants (n = 72; age = 44 ± 13 years) were assigned randomly to control (n = 10) or one of five 13-week exercise programs: (1) 10-min brisk walking 1×/week (n = 10), (2) 10-min brisk walking 3×/week (n = 10), (3) 30-min brisk walking 3×/week (n = 18), (4) 60-min brisk walking 3×/week (n = 10), and (5) 30-min running 3×/week (n = 14), in addition to their regular physical activity. Health measures evaluated pre- and post-training including blood pressure, body composition, fasting lipids and glucose, and maximal aerobic power (VO2max). Health improvements were observed among programs at least 30 min in duration, including body composition and VO2max: 30-min walking 28.8-34.5 mL kg(-1) min(-1), 60-min walking 25.1-28.9 mL kg(-1) min(-1), and 30-min running 32.4-36.4 mL kg(-1) min(-1). The greater intensity running program also demonstrated improvements in triglycerides. In healthy active individuals, a physical activity program of at least 30 min in duration for three sessions/per week is associated with consistent improvements in health status.

PoleStriding exercise and vitamin E for management of peripheral vascular disease.

PubMed

Collins, Eileen G; Edwin Langbein, W; Orebaugh, Cynthia; Bammert, Christine; Hanson, Karla; Reda, Domenic; Edwards, Lonnie C; Littooy, Fred N

2003-03-01

The purpose of this investigation was to evaluate the efficacy of PoleStriding exercise (a form of walking that uses muscles of the upper and lower body in a continuous movement similar to cross-country skiing) and vitamin E (alpha-tocopherol) to improve walking ability and perceived quality of life (QOL) of patients with claudication pain secondary to peripheral arterial disease (PAD). Fifty-two subjects were randomized into four groups: PoleStriding with vitamin E (N = 13), PoleStriding with placebo (N= 14), vitamin E without exercise (N= 13), and placebo without exercise (N = 12). The dose of vitamin E was 400 IU daily. Only the PoleStriding with vitamin E and PoleStriding with placebo groups received PoleStriding instruction and training. Assignment to vitamin E or placebo was double blind. Subjects trained three times weekly for 30-45 min (rest time excluded). Individuals in vitamin E and placebo groups came to the laboratory biweekly for ankle blood-pressure measurements. Results of this randomized clinical trial provide strong evidence that PoleStriding significantly (P< 0.001) improved exercise tolerance on the constant work-rate and incremental treadmill tests. Ratings of perceived claudication pain were significantly less after the PoleStriding training program (P= 0.02). In contrast, vitamin E did not have a statistically significant effect on the subjects' ratings of perceived leg pain (P= 0.35) or treadmill walking duration ( P= 0.36). Perceived distance and walking speed (Walking Impairment Questionnaire) and perceived physical function (Rand Short Form-36) improved in the PoleStriding trained group only (P< 0.001, 0.022 and 0.003, respectively). PoleStriding effectively improved the exercise tolerance and perceived QOL of patients with PAD. Little additional benefit to exercise capacity was realized from vitamin E supplementation.

Feasibility of robotic exoskeleton ambulation in a C4 person with incomplete spinal cord injury: a case report.

PubMed

Lester, Robert M; Gorgey, Ashraf S

2018-01-01

To determine whether an individual with C4 incomplete spinal cord injury (SCI) with limited hand functions can effectively operate a powered exoskeleton (Ekso) to improve parameters of physical activity as determined by swing-time, up-time, walk-time, and total number of steps. A 21-year-old male with incomplete chronic (>1 year postinjury) SCI C4, participated in a clinical exoskeleton program to determine the feasibility of standing up and walking with limited hand functions. The participant was invited to attend 3 sessions including fitting, familiarization and gait training separated by one week intervals. Walk-time, up-time and total number of steps were measured during each training session. A complete body composition assessment using dual-energy X-ray absorptiometry (DXA) of the spine, knees and hips was conducted before training.Using a platform walker and cuffing both hands, the participant managed to stand up and ambulate successfully using exoskeleton. Over the course of 2 weeks, maximum walk-time increased from 7 to 17 min and number of steps increased from 83 to 589 steps. The total up-time increased from 19 to 31 min. Exoskeleton training may be a safe and feasible approach for persons with higher levels of SCI after effectively providing a supportive assistive device for weight shifting. The current case study demonstrates the use of a powered exoskeleton for an individual with high level tetraplegia (C4 and above) and limited hand functions.

Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence

PubMed Central

Tang, Pei Fang

2011-01-01

Stroke is a leading cause of long-term disability. Impairments resulting from stroke lead to persistent difficulties with walking and subsequently, improved walking ability is one of the highest priorities for people living with a stroke. In addition, walking ability has important health implications in providing protective effects against secondary complications common after a stroke such as heart disease or osteoporosis. This paper systematically reviews common gait training strategies (neurodevelopmental techniques, muscle strengthening, treadmill training, intensive mobility exercises) to improve walking ability. The results (descriptive summaries as well as pooled effect sizes) from randomized controlled trials are presented and implications for optimal gait training strategies are discussed. Novel and emerging gait training strategies are highlighted and research directions proposed to enable the optimal recovery and maintenance of walking ability. PMID:17939776

Robot-assisted gait training in multiple sclerosis: a pilot randomized trial.

PubMed

Beer, S; Aschbacher, B; Manoglou, D; Gamper, E; Kool, J; Kesselring, J

2008-03-01

To evaluate feasibility and perform an explanatory analysis of the efficacy of robot-assisted gait training (RAGT) in MS patients with severe walking disabilities (Expanded Disability Status Scale [EDSS] 6.0-7.5) in a pilot trial. Prospective, randomized, controlled clinical trial comparing RAGT with conventional walking training (CWT) in a group of stable MS patients (n = 35) during an inpatient rehabilitation stay, 15 sessions over three weeks. All patients participated additionally in a multimodal rehabilitation program. The primary outcome measure was walking velocity and secondary measures were 6-min-walking distance, stride length and knee-extensor strength. All tests were performed by an external blinded assessor at baseline after three weeks and at follow-up after six months. Additionally, Extended Barthel Index (EBI) at entry and discharge was assessed (not blinded), and acceptance/convenience of RAGT rated by patients (Visual Analogue Scale [VAS]) was recorded. Nineteen patients were randomly allocated to RAGT and 16 patients to CWT. Groups were comparable at baseline. There were 5 drop-outs (2 related directly to treatment) in the RAGT group and 1 in the CWT group, leaving 14 RAGT patients and 15 CWT patients for final analysis. Acceptance and convenience of RAGT as rated by patients were high. Effect sizes were moderate to large, although not significant, for walking velocity (0.700, 95% CI -0.089 to 1.489), walking distance (0.401, 95% CI - 0.370 to 1.172) and knee-extensor strength (right: 1.105, 95% CI 0.278 to 1.932, left 0.650, 95% CI -0.135 to 1.436) favouring RAGT. Prepost within-group analysis revealed an increase of walking velocity, walking distance and knee-extensor strength in the RAGT group, whereas in CWT group only walking velocity was improved. In both groups outcome values returned to baseline at follow-up after six months (n = 23). Robot-assisted gait training is feasible and may be an effective therapeutic option in MS patients with severe walking disabilities. Effect size calculation and prepost analysis suggest a higher benefit on walking velocity and knee-extensor strength by RAGT compared to CWT. Due to several limitations, however, our results should be regarded as preliminary. Post hoc power calculation showed that two groups of 106 patients are needed to demonstrate a significant moderate effect size of 0.4 after three weeks of RAGT. Thus, further studies with a larger number of patients are needed to investigate the impact of this new treatment option in MS patients.

Early application of tail nerve electrical stimulation-induced walking training promotes locomotor recovery in rats with spinal cord injury.

PubMed

Zhang, S-X; Huang, F; Gates, M; Shen, X; Holmberg, E G

2016-11-01

This is a randomized controlled prospective trial with two parallel groups. The objective of this study was to determine whether early application of tail nerve electrical stimulation (TANES)-induced walking training can improve the locomotor function. This study was conducted in SCS Research Center in Colorado, USA. A contusion injury to spinal cord T10 was produced using the New York University impactor device with a 25 -mm height setting in female, adult Long-Evans rats. Injured rats were randomly divided into two groups (n=12 per group). One group was subjected to TANES-induced walking training 2 weeks post injury, and the other group, as control, received no TANES-induced walking training. Restorations of behavior and conduction were assessed using the Basso, Beattie and Bresnahan open-field rating scale, horizontal ladder rung walking test and electrophysiological test (Hoffmann reflex). Early application of TANES-induced walking training significantly improved the recovery of locomotor function and benefited the restoration of Hoffmann reflex. TANES-induced walking training is a useful method to promote locomotor recovery in rats with spinal cord injury.

Treadmill training and body weight support for walking after stroke.

PubMed

Mehrholz, Jan; Thomas, Simone; Elsner, Bernhard

2017-08-17

Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of the Cochrane review first published in 2003 and updated in 2005 and 2014. To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait-training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. We searched the Cochrane Stroke Group Trials Register (last searched 14 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (the Cochrane Library 2017, Issue 2), MEDLINE (1966 to 14 February 2017), Embase (1980 to 14 February 2017), CINAHL (1982 to 14 February 2017), AMED (1985 to 14 February 2017) and SPORTDiscus (1949 to 14 February 2017). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists, and contacted trialists to identify further trials. Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. Two review authors independently selected trials, extracted data, and assessed risk of bias and methodological quality. The primary outcomes investigated were walking speed, endurance, and dependency. We included 56 trials with 3105 participants in this updated review. The average age of the participants was 60 years, and the studies were carried out in both inpatient and outpatient settings. All participants had at least some walking difficulties and many could not walk without assistance. Overall, the use of treadmill training did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; 18 trials, 1210 participants; P = 0.94; I² = 0%; low-quality evidence). Overall, the use of treadmill training in walking rehabilitation for people after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.06 m/s (95% CI 0.03 to 0.09; 47 trials, 2323 participants; P < 0.0001; I² = 44%; moderate-quality evidence) and the pooled MD for walking endurance was 14.19 metres (95% CI 2.92 to 25.46; 28 trials, 1680 participants; P = 0.01; I² = 27%; moderate-quality evidence). Overall, the use of treadmill training with body weight support in walking rehabilitation for people after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up. The pooled MD (random-effects model) for walking velocity was 0.03 m/s (95% CI -0.05 to 0.10; 12 trials, 954 participants; P = 0.50; I² = 55%; low-quality evidence) and the pooled MD for walking endurance was 21.64 metres (95% CI -4.70 to 47.98; 10 trials, 882 participants; P = 0.11; I² = 47%; low-quality evidence). In 38 studies with a total of 1571 participants who were independent in walking at study onset, the use of treadmill training increased the walking velocity significantly. The pooled MD (random-effects model) for walking velocity was 0.08 m/s (95% CI 0.05 to 0.12; P < 0.00001; I 2 = 49%). There were insufficient data to comment on any effects on quality of life or activities of daily living. Adverse events and dropouts did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. Overall, people after stroke who receive treadmill training, with or without body weight support, are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve slightly in the short term. Specifically, people with stroke who are able to walk (but not people who are dependent in walking at start of treatment) appear to benefit most from this type of intervention with regard to walking speed and walking endurance. This review did not find, however, that improvements in walking speed and endurance may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations, or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory participants, but not in dependent walkers.

Kinematic Adaptations of Forward And Backward Walking on Land and in Water

PubMed Central

Cadenas-Sanchez, Cristina; Arellano, Raúl; Vanrenterghem, Jos; López-Contreras, Gracia

2015-01-01

The aim of this study was to compare sagittal plane lower limb kinematics during walking on land and submerged to the hip in water. Eight healthy adults (age 22.1 ± 1.1 years, body height 174.8 ± 7.1 cm, body mass 63.4 ± 6.2 kg) were asked to cover a distance of 10 m at comfortable speed with controlled step frequency, walking forward or backward. Sagittal plane lower limb kinematics were obtained from three dimensional video analysis to compare spatiotemporal gait parameters and joint angles at selected events using two-way repeated measures ANOVA. Key findings were a reduced walking speed, stride length, step length and a support phase in water, and step length asymmetry was higher compared to the land condition (p<0.05). At initial contact, knees and hips were more flexed during walking forward in water, whilst, ankles were more dorsiflexed during walking backward in water. At final stance, knees and ankles were more flexed during forward walking, whilst the hip was more flexed during backward walking. These results show how walking in water differs from walking on land, and provide valuable insights into the development and prescription of rehabilitation and training programs. PMID:26839602

Variety Wins: Soccer-Playing Robots and Infant Walking

PubMed Central

Ossmy, Ori; Hoch, Justine E.; MacAlpine, Patrick; Hasan, Shohan; Stone, Peter; Adolph, Karen E.

2018-01-01

Although both infancy and artificial intelligence (AI) researchers are interested in developing systems that produce adaptive, functional behavior, the two disciplines rarely capitalize on their complementary expertise. Here, we used soccer-playing robots to test a central question about the development of infant walking. During natural activity, infants' locomotor paths are immensely varied. They walk along curved, multi-directional paths with frequent starts and stops. Is the variability observed in spontaneous infant walking a “feature” or a “bug?” In other words, is variability beneficial for functional walking performance? To address this question, we trained soccer-playing robots on walking paths generated by infants during free play and tested them in simulated games of “RoboCup.” In Tournament 1, we compared the functional performance of a simulated robot soccer team trained on infants' natural paths with teams trained on less varied, geometric paths—straight lines, circles, and squares. Across 1,000 head-to-head simulated soccer matches, the infant-trained team consistently beat all teams trained with less varied walking paths. In Tournament 2, we compared teams trained on different clusters of infant walking paths. The team trained with the most varied combination of path shape, step direction, number of steps, and number of starts and stops outperformed teams trained with less varied paths. This evidence indicates that variety is a crucial feature supporting functional walking performance. More generally, we propose that robotics provides a fruitful avenue for testing hypotheses about infant development; reciprocally, observations of infant behavior may inform research on artificial intelligence. PMID:29867427

Comparison of a robotic-assisted gait training program with a program of functional gait training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial.

PubMed

Hilderley, Alicia J; Fehlings, Darcy; Lee, Gloria W; Wright, F Virginia

2016-01-01

Enhancement of functional ambulation is a key goal of rehabilitation for children with cerebral palsy (CP) who experience gross motor impairment. Physiotherapy (PT) approaches often involve overground and treadmill-based gait training to promote motor learning, typically as free walking or with body-weight support. Robotic-assisted gait training (RAGT), using a device such as the Lokomat ® Pro, may permit longer training duration, faster and more variable gait speeds, and support walking pattern guidance more than overground/treadmill training to further capitalize on motor learning principles. Single group pre-/post-test studies have demonstrated an association between RAGT and moderate to large improvements in gross motor skills, gait velocity and endurance. A single published randomized controlled trial (RCT) comparing RAGT to a PT-only intervention showed no difference in gait kinematics. However, gross motor function and walking endurance were not evaluated and conclusions were limited by a large PT group drop-out rate. In this two-group cross-over RCT, children are randomly allocated to the RAGT or PT arm (each with twice weekly sessions for eight weeks), with cross-over to the other intervention arm following a six-week break. Both interventions are grounded in motor learning principles with incorporation of individualized mobility-based goals. Sessions are fully operationalized through manualized, menu-based protocols and post-session documentation to enhance internal and external validity. Assessments occur pre/post each intervention arm (four time points total) by an independent assessor. The co-primary outcomes are gross motor functional ability (Gross Motor Function Measure (GMFM-66) and 6-minute walk test), with secondary outcome measures assessing: (a) individualized goals; (b) gait variables and daily walking amounts; and (c) functional abilities, participation and quality of life. Investigators and statisticians are blinded to study group allocation in the analyses, and assessors are blinded to treatment group. The primary analysis will be the pre- to post-test differences (change scores) of the GMFM-66 and 6MWT between RAGT and PT groups. This study is the first RCT comparing RAGT to an active gait-related PT intervention in paediatric CP that addresses gait-related gross motor, participation and individualized outcomes, and as such, is expected to provide comprehensive information as to the potential role of RAGT in clinical practice. Trial registration ClinicalTrials.gov NCT02196298.

Early 4-week cardiac rehabilitation exercise training in elderly patients after heart surgery.

PubMed

Eder, Barbara; Hofmann, Peter; von Duvillard, Serge P; Brandt, Dieter; Schmid, Jean-Paul; Pokan, Rochus; Wonisch, Manfred

2010-01-01

The aim of this study was to assess the effects on exercise performance of supplementing a standard cardiac rehabilitation program with additional exercise programming compared to the standard cardiac rehabilitation program alone in elderly patients after heart surgery. In this prospective, randomized controlled trial, 60 patients (32 men and 28 women, mean age 73.1 +/- 4.7 years) completed cardiac rehabilitation (initiated 12.2 +/- 4.9 days postsurgery). Subjects were assigned to either a control group (CG, standard cardiac rehabilitation program [n = 19]), or an intervention group (IG, additional walking [n = 19], or cycle ergometry training [n = 22]). A symptom limited cardiopulmonary exercise test and 6-minute walk test (6MWT) were performed before and after 4 weeks of cardiac rehabilitation. The MacNew questionnaire was used to assess quality of life (QOL). At baseline, no significant differences for peak oxygen uptake ((.)VO2), maximal power output, or the 6MWT were detected between IG and CG. Global QOL was significantly higher in IG. After 4 weeks of cardiac rehabilitation, patients significantly improved in absolute values of the cardiopulmonary exercise test, 6MWT, and QOL scores. Significant differences between groups were found for peak (.)VO2 (IG: 18.2 +/- 3.1 mL x kg x min vs. CG: 16.5 +/- 2.2 mL x kg x min, P < .05); maximal power output (IG: 72.2 +/- 16 W vs. CG: 60.7 +/- 15 W, P < .05); 6MWT (IG: 454.8 +/- 76.3 m vs. CG: 400.5 +/- 75.5 m, P < .05); and QOL global (IG: 6.5 +/- 0.5 vs. CG: 6.3 +/- 0.6, P < .05). The supplementation of additional walking or cycle exercise training to standard cardiac rehabilitation programming compared to standard cardiac rehabilitation alone in elderly patients after heart surgery leads to significantly better exercise tolerance.

Influence of a Locomotor Training Approach on Walking Speed and Distance in People With Chronic Spinal Cord Injury: A Randomized Clinical Trial

PubMed Central

Roach, Kathryn E.

2011-01-01

Background Impaired walking limits function after spinal cord injury (SCI), but training-related improvements are possible even in people with chronic motor incomplete SCI. Objective The objective of this study was to compare changes in walking speed and distance associated with 4 locomotor training approaches. Design This study was a single-blind, randomized clinical trial. Setting This study was conducted in a rehabilitation research laboratory. Participants Participants were people with minimal walking function due to chronic SCI. Intervention Participants (n=74) trained 5 days per week for 12 weeks with the following approaches: treadmill-based training with manual assistance (TM), treadmill-based training with stimulation (TS), overground training with stimulation (OG), and treadmill-based training with robotic assistance (LR). Measurements Overground walking speed and distance were the primary outcome measures. Results In participants who completed the training (n=64), there were overall effects for speed (effect size index [d]=0.33) and distance (d=0.35). For speed, there were no significant between-group differences; however, distance gains were greatest with OG. Effect sizes for speed and distance were largest with OG (d=0.43 and d=0.40, respectively). Effect sizes for speed were the same for TM and TS (d=0.28); there was no effect for LR. The effect size for distance was greater with TS (d=0.16) than with TM or LR, for which there was no effect. Ten participants who improved with training were retested at least 6 months after training; walking speed at this time was slower than that at the conclusion of training but remained faster than before training. Limitations It is unknown whether the training dosage and the emphasis on training speed were optimal. Robotic training that requires active participation would likely yield different results. Conclusions In people with chronic motor incomplete SCI, walking speed improved with both overground training and treadmill-based training; however, walking distance improved to a greater extent with overground training. PMID:21051593

Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy.

PubMed

Aye, Thanda; Thein, Soe; Hlaing, Thaingi

2016-01-01

[Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy.

Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy

PubMed Central

Aye, Thanda; Thein, Soe; Hlaing, Thaingi

2016-01-01

[Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy. PMID:27065561

Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: a randomized controlled trial.

PubMed

Kalron, Alon; Rosenblum, Uri; Frid, Lior; Achiron, Anat

2017-03-01

Evaluate the effects of a Pilates exercise programme on walking and balance in people with multiple sclerosis and compare this exercise approach to conventional physical therapy sessions. Randomized controlled trial. Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Forty-five people with multiple sclerosis, 29 females, mean age (SD) was 43.2 (11.6) years; mean Expanded Disability Status Scale (S.D) was 4.3 (1.3). Participants received 12 weekly training sessions of either Pilates ( n=22) or standardized physical therapy ( n=23) in an outpatient basis. Spatio-temporal parameters of walking and posturography parameters during static stance. Functional tests included the Time Up and Go Test, 2 and 6-minute walk test, Functional Reach Test, Berg Balance Scale and the Four Square Step Test. In addition, the following self-report forms included the Multiple Sclerosis Walking Scale and Modified Fatigue Impact Scale. At the termination, both groups had significantly increased their walking speed ( P=0.021) and mean step length ( P=0.023). According to the 2-minute and 6-minute walking tests, both groups at the end of the intervention program had increased their walking speed. Mean (SD) increase in the Pilates and physical therapy groups were 39.1 (78.3) and 25.3 (67.2) meters, respectively. There was no effect of group X time in all instrumented and clinical balance and gait measures. Pilates is a possible treatment option for people with multiple sclerosis in order to improve their walking and balance capabilities. However, this approach does not have any significant advantage over standardized physical therapy.

Efficacy of a cell phone-based exercise programme for COPD.

PubMed

Liu, W-T; Wang, C-H; Lin, H-C; Lin, S-M; Lee, K-Y; Lo, Y-L; Hung, S-H; Chang, Y-M; Chung, K F; Kuo, H-P

2008-09-01

The application of a supervised endurance exercise training programme in a home setting offering convenience and prolonged effects is a challenge. In total, 48 patients were initially assessed by the incremental shuttle walk test (ISWT), spirometry and the Short Form-12 (SF-12) quality-of-life questionnaire, and then every 4 weeks for 3 months thereafter and again after 1 yr. During the first 3 months, 24 patients in the cell phone group were asked to perform daily endurance walking at 80% of their maximal capacity by following the tempo of music from a program installed on a cell phone. The level of endurance walking at home was readjusted monthly according to the result of ISWT. In the control group, 24 patients received the same protocol and were verbally asked to take daily walking exercise at home. Patients in the cell phone group significantly improved their ISWT distance and duration of endurance walking after 8 weeks. The improvements in ISWT distance, inspiratory capacity and SF-12 scoring at 12 weeks persisted until the end of the study, with less acute exacerbations and hospitalisations. In the present pilot study, the cell phone-based system provides an efficient, home endurance exercise training programme with good compliance and clinical outcomes in patients with moderate-to-severe chronic obstructive pulmonary disease.

Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability.

PubMed

Kuys, Suzanne; Brauer, Sandra; Ada, Louise

2006-12-01

Cardiorespiratory fitness is increasingly being recognized as an impairment requiring physiotherapy intervention after stroke. The present study seeks to investigate if routine physiotherapy treatment is capable of inducing a cardiorespiratory training effect and if stroke patients attending physiotherapy who are unable to walk experience less cardiorespiratory stress during physiotherapy when compared to those who are able to walk. A descriptive, observational study, with heart rate monitoring and video-recording of physiotherapy rehabilitation, was conducted. Thirty consecutive stroke patients from a geriatric and rehabilitation unit of a tertiary metropolitan hospital, admitted for rehabilitation, and requiring physiotherapy were included in the study. The main measures of the study were duration (time) and intensity (percentage of heart rate reserve) of standing and walking activities during physiotherapy rehabilitation for non-walking and walking stroke patients. Stroke patients spent an average of 21 minutes participating in standing and walking activities that were capable of inducing a cardiorespiratory training effect. Stroke patients who were able to walk spent longer in these activities during physiotherapy rehabilitation than non-walking stroke patients (p < 0.05). An average intensity of 24% heart rate reserve (HRR) during standing and walking activities was insufficient to result in a cardiorespiratory training effect, with a maximum of 35% achieved for the stroke patients able to walk and 30% for those unable to walk. Routine physiotherapy rehabilitation had insufficient duration and intensity to result in a cardiorespiratory training effect in our group of stroke patients.

The effect of impedance-controlled robotic gait training on walking ability and quality in individuals with chronic incomplete spinal cord injury: an explorative study.

PubMed

Fleerkotte, Bertine M; Koopman, Bram; Buurke, Jaap H; van Asseldonk, Edwin H F; van der Kooij, Herman; Rietman, Johan S

2014-03-04

There is increasing interest in the use of robotic gait-training devices in walking rehabilitation of incomplete spinal cord injured (iSCI) individuals. These devices provide promising opportunities to increase the intensity of training and reduce physical demands on therapists. Despite these potential benefits, robotic gait-training devices have not yet demonstrated clear advantages over conventional gait-training approaches, in terms of functional outcomes. This might be due to the reduced active participation and step-to-step variability in most robotic gait-training strategies, when compared to manually assisted therapy. Impedance-controlled devices can increase active participation and step-to-step variability. The aim of this study was to assess the effect of impedance-controlled robotic gait training on walking ability and quality in chronic iSCI individuals. A group of 10 individuals with chronic iSCI participated in an explorative clinical trial. Participants trained three times a week for eight weeks using an impedance-controlled robotic gait trainer (LOPES: LOwer extremity Powered ExoSkeleton). Primary outcomes were the 10-meter walking test (10 MWT), the Walking Index for Spinal Cord Injury (WISCI II), the six-meter walking test (6 MWT), the Timed Up and Go test (TUG) and the Lower Extremity Motor Scores (LEMS). Secondary outcomes were spatiotemporal and kinematics measures. All participants were tested before, during, and after training and at 8 weeks follow-up. Participants experienced significant improvements in walking speed (0.06 m/s, p = 0.008), distance (29 m, p = 0.005), TUG (3.4 s, p = 0.012), LEMS (3.4, p = 0.017) and WISCI after eight weeks of training with LOPES. At the eight-week follow-up, participants retained the improvements measured at the end of the training period. Significant improvements were also found in spatiotemporal measures and hip range of motion. Robotic gait training using an impedance-controlled robot is feasible in gait rehabilitation of chronic iSCI individuals. It leads to improvements in walking ability, muscle strength, and quality of walking. Improvements observed at the end of the training period persisted at the eight-week follow-up. Slower walkers benefit the most from the training protocol and achieve the greatest relative improvement in speed and walking distance.

The effect of impedance-controlled robotic gait training on walking ability and quality in individuals with chronic incomplete spinal cord injury: an explorative study

PubMed Central

2014-01-01

Background There is increasing interest in the use of robotic gait-training devices in walking rehabilitation of incomplete spinal cord injured (iSCI) individuals. These devices provide promising opportunities to increase the intensity of training and reduce physical demands on therapists. Despite these potential benefits, robotic gait-training devices have not yet demonstrated clear advantages over conventional gait-training approaches, in terms of functional outcomes. This might be due to the reduced active participation and step-to-step variability in most robotic gait-training strategies, when compared to manually assisted therapy. Impedance-controlled devices can increase active participation and step-to-step variability. The aim of this study was to assess the effect of impedance-controlled robotic gait training on walking ability and quality in chronic iSCI individuals. Methods A group of 10 individuals with chronic iSCI participated in an explorative clinical trial. Participants trained three times a week for eight weeks using an impedance-controlled robotic gait trainer (LOPES: LOwer extremity Powered ExoSkeleton). Primary outcomes were the 10-meter walking test (10MWT), the Walking Index for Spinal Cord Injury (WISCI II), the six-meter walking test (6MWT), the Timed Up and Go test (TUG) and the Lower Extremity Motor Scores (LEMS). Secondary outcomes were spatiotemporal and kinematics measures. All participants were tested before, during, and after training and at 8 weeks follow-up. Results Participants experienced significant improvements in walking speed (0.06 m/s, p = 0.008), distance (29 m, p = 0.005), TUG (3.4 s, p = 0.012), LEMS (3.4, p = 0.017) and WISCI after eight weeks of training with LOPES. At the eight-week follow-up, participants retained the improvements measured at the end of the training period. Significant improvements were also found in spatiotemporal measures and hip range of motion. Conclusion Robotic gait training using an impedance-controlled robot is feasible in gait rehabilitation of chronic iSCI individuals. It leads to improvements in walking ability, muscle strength, and quality of walking. Improvements observed at the end of the training period persisted at the eight-week follow-up. Slower walkers benefit the most from the training protocol and achieve the greatest relative improvement in speed and walking distance. PMID:24594284

The effects of gait training with body weight support (BWS) with no body weight support (no-BWS) in stroke patients.

PubMed

Ullah, Muhammad Asad; Shafi, Hina; Khan, Ghazanfar Ali; Malik, Arshad Nawaz; Amjad, Imran

2017-07-01

The purpose of this study was to measure the clinical outcomes for patients with stroke after gait training with body weight support (BWS) and with no body weight support (no-BWS).Experimental group was trained to walk by a BWS system with overhead harness (BWS group), and Control group was trained with full weight bearing walk on their lower extremities. Treatment session comprised of six weeks training. Treatment outcomes were assessed on the basis of Timed 10 Meter Walk Test, Timed Get Up and Go Test and Dynamic Gait Index. There was a significant (P<0.05) difference in BWS and NBWS for Dynamic Gait Index, Timed Get Up and Go Test, Timed 10 Meter Walk Test (Self-Selected Velocity), and Timed 10 Meter Walk Test (Fast-Velocity). Training of gait in stroke patients while a percentage of their body weight supported by a harness, resulted in better walking abilities than the Training of gait while full weight was placed on patient's lower extremities.

The effect of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation.

PubMed

Miller, Carol A; Williams, Jennifer E; Durham, Katey L; Hom, Selena C; Smith, Julie L

2017-10-01

Many individuals with lower limb loss report concern with walking ability after completing structured traditional rehabilitation. The purpose of this study was to explore the impact of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation. Repeated measures. The supervised exercise program was offered biweekly for 6 weeks. The GAITRite System by CIR Systems, Inc., the Figure-of-8 Walk Test, and Activity-specific Balance Confidence Scale were used to measure clinical outcomes pre- and post-intervention. In total, 16 participants with lower limb amputation (mean age: 50.8 years) completed the study. A multivariate, repeated measures analysis of variance indicated a statistically significant effect of training across six clinical outcome measures ( F(6, 10) = 4.514, p = .018). Moderate effect sizes were found for the Figure-of-8 Walk Test ( η 2 = .586), Activity-specific Balance Confidence Scale ( η 2 = .504), and gait velocity at comfortable walking speed ( η 2 = .574). The average increase in gait speed was clinically meaningful at .14 m/s. The supervised community-based exercise program implemented in this study was designed to address specific functional needs for individuals with lower limb loss. Each participant experienced clinically meaningful improvements in balance, balance confidence, and walking ability. Clinical relevance The provision of a supervised community-based exercise program, after traditional rehabilitation, provides opportunity to offer a continuum of care that may enhance prosthetic functional ability and active participation in the community for individuals with lower limb amputation.

Blood flow restricted resistance training in older adults at risk of mobility limitations.

PubMed

Cook, Summer B; LaRoche, Dain P; Villa, Michelle R; Barile, Hannah; Manini, Todd M

2017-12-01

High-load resistance training (HL) may be contraindicated in older adults due to pre-existing health conditions (e.g. osteoarthritis). Low-load blood flow restricted (BFR) resistance training offers an alternative to HL with potentially similar strength improvement. To compare muscle strength, cross-sectional area (CSA), physical function, and quality of life (QOL) following 12-weeks of HL or BFR training in older adults at risk of mobility limitations. Thirty-six males and females (mean: 75.6years 95% confidence interval: [73.4-78.5], 1.67m [1.64-1.70], 74.3kg [69.8-78.8]) were randomly assigned to HL (70% of one repetition maximum [1-RM]) or low-load BFR (30% 1-RM coupled with a vascular restriction) exercise for the knee extensors and flexors twice per week for 12weeks. A control (CON) group performed light upper body resistance and flexibility training. Muscle strength, CSA of the quadriceps, 400-m walking speed, Short Physical Performance Battery (SPPB), and QOL were assessed before, midway and after training. Within 6-weeks of HL training, increases in all strength measures and CSA were evident and the gains were significantly greater than the CON group (P<0.05). The BFR group had strength increases in leg extension and leg press 1-RM tests, but were significantly lower in leg extension isometric maximum voluntary contraction (MVC) and leg extension 1-RM than the HL group (P<0.01). At 12-weeks HL and BFR training did not differ in MVC (P=0.14). Walking speed increased 4% among all training groups (P<0.01) and no changes were observed for overall SPPB score and QOL (P>0.05). Both training programs resulted in muscle CSA improvements and HL training had more pronounced strength gains than BFR training after 6-weeks and were more similar to BFR after 12-weeks of training. These changes in both groups did not transfer to improvements in QOL, SPPB, and walking speed. Since both programs result in strength and CSA gains, albeit at different rates, future research should consider using a combination of HL and BFR training in older adults with profound muscle weakness and mobility limitations. Copyright © 2017 Elsevier Inc. All rights reserved.

`An observational report of intensive robotic and manual gait training in sub-acute stroke

PubMed Central

2012-01-01

Background The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training. Methods We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales. Results Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training. Conclusions Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training. PMID:22329866

Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up

PubMed Central

Eggenberger, Patrick; Schumacher, Vera; Angst, Marius; Theill, Nathan; de Bruin, Eling D

2015-01-01

Background Cognitive impairment is a health problem that concerns almost every second elderly person. Physical and cognitive training have differential positive effects on cognition, but have been rarely applied in combination. This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults. We hypothesized that simultaneous cognitive–physical components would add training specific cognitive benefits compared to exclusively physical training. Methods Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Cognitive performance was assessed at baseline, after 3 and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were calculated. Results Eighty-nine participants were randomized to the three groups initially, 71 completed the training, while 47 were available at 1-year follow-up. Advantages of the simultaneous cognitive–physical programs were found in two dimensions of executive function. “Shifting attention” showed a time×intervention interaction in favor of DANCE/MEMORY versus PHYS (F[2, 68] =1.95, trend P=0.075, r=0.17); and “working memory” showed a time×intervention interaction in favor of DANCE versus MEMORY (F[1, 136] =2.71, trend P=0.051, R2=0.006). Performance improvements in executive functions, long-term visual memory (episodic memory), and processing speed were maintained at follow-up in all groups. Conclusion Particular executive functions benefit from simultaneous cognitive–physical training compared to exclusively physical multicomponent training. Cognitive–physical training programs may counteract widespread cognitive impairments in the elderly. PMID:26316729

Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up.

PubMed

Eggenberger, Patrick; Schumacher, Vera; Angst, Marius; Theill, Nathan; de Bruin, Eling D

2015-01-01

Cognitive impairment is a health problem that concerns almost every second elderly person. Physical and cognitive training have differential positive effects on cognition, but have been rarely applied in combination. This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults. We hypothesized that simultaneous cognitive-physical components would add training specific cognitive benefits compared to exclusively physical training. Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Cognitive performance was assessed at baseline, after 3 and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were calculated. Eighty-nine participants were randomized to the three groups initially, 71 completed the training, while 47 were available at 1-year follow-up. Advantages of the simultaneous cognitive-physical programs were found in two dimensions of executive function. "Shifting attention" showed a time×intervention interaction in favor of DANCE/MEMORY versus PHYS (F[2, 68] =1.95, trend P=0.075, r=0.17); and "working memory" showed a time×intervention interaction in favor of DANCE versus MEMORY (F[1, 136] =2.71, trend P=0.051, R (2)=0.006). Performance improvements in executive functions, long-term visual memory (episodic memory), and processing speed were maintained at follow-up in all groups. Particular executive functions benefit from simultaneous cognitive-physical training compared to exclusively physical multicomponent training. Cognitive-physical training programs may counteract widespread cognitive impairments in the elderly.

Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD.

PubMed

Behnke, Michaela; Wewel, Alexandra R; Kirsten, Detlef; Jörres, Rudolf A; Magnussen, Helgo

2005-06-01

The 6-min walking (6MWD) and 6-min treadmill distance (6MTD) are often used as measures of exercise performance in patients with COPD. The aim of our study was to assess their relationship to daily activity in the course of an exercise training program. Eighty-eight patients with stable COPD (71m/17f; mean +/- SD age, 60 +/-8 year; FEV1, 43+/-14% pred) were recruited, 66 of whom performed a hospital-based 10-day walking training, whereas 22 were treated as control. On day 16MTD, and on days 8 and 10, 6MTD and 6MWD were determined. In addition, patients used an accelerometer (TriTrac-R3D) to record 24 h-activity, whereby training sessions were excluded. In both groups there was a linear relationship (r > or = 0.84 and P < 0.0001) between 6MTD and 24 h-activity, the slope of which was 2.5-fold greater in the training group (P < 0.01). Similar relationships emerged for 6MWD. There was no association between baseline 6MTD, FEV1 or BMI and any of the other measures. These data suggest that daily activity did not markedly vary with exercise capacity under baseline conditions. Participation in a training program increased activity significantly stronger than predicted from the gain in exercise capacity. This underlines the importance of non-physiological, patient-centered factors associated with training in COPD.

Study on an advanced early rehabilitation training system for postural control using a tilting bed

NASA Astrophysics Data System (ADS)

Yu, Chang-Ho; Kim, Kyong; Kwon, Tae-Kyu; Hong, Chul-Un; Kim, Nam-Gyun

2005-12-01

It proposed a new early rehabilitation training system for postural control using a tilting bed, a visual display and a force plate. The conventional rehabilitation systems for postural control can't be applied to the patients lying in bed because the rehabilitation training using those systems is only possible when the patient can stand up by himself or herself. Moreover, there did not exist any device that could provide the sense of balance or the sensation of walking to the patients in bed. The software for the system consists of the training program and the analysis program. The training program was designed to improve the ability of postural control of the subjects by repeated training of moving the center of pressure (COP) applied to the forceplate. The training program consists of the COP maintaining training and the COP movement training in horizontal, vertical, 45° and -45° directions. The analysis program consists of the COP moving time analysis modules, the COP maintaining time analysis module. Through the experiments with real people, it verified the effectiveness of the new early rehabilitation training system. The results showe that this system is an effective system for early rehabilitation training and that our system might be useful as clinical equipment.

Walk-through survey report: Control technology for metal reclamation industries at Exide/General Battery Corporation, Reading, Pennsylvania

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hall, R.M.

1994-03-30

A walk through survey was made at Exide/General Battery Corporation, Reading, Pennsylvania to identify and evaluate control methods to reduce lead exposure. About 20,000 to 25,000 batteries a day were recycled, primarily automobile batteries. Lead and plastic from the batteries were reclaimed. The company used local exhaust ventilation, enclosed ventilated booths, partial enclosures, and automated operations throughout production areas of the site. Various occupational safety and health programs were in place including occupational and safety training, a respiratory protection program, various hygiene programs, and blood lead monitoring programs. These findings will be compared with those from other sites and themore » facility with the lowest lead exposure levels will be examined carefully so that others may be brought in line with the best of standards.« less

Treadmill Training or Progressive Strength Training to Improve Walking in People with Multiple Sclerosis? A Randomized Parallel Group Trial.

PubMed

Braendvik, Siri Merete; Koret, Teija; Helbostad, Jorunn L; Lorås, Håvard; Bråthen, Geir; Hovdal, Harald Olav; Aamot, Inger Lise

2016-12-01

The most effective treatment approach to improve walking in people with multiple sclerosis (MS) is not known. The aim of this trial was to assess the efficacy of treadmill training and progressive strength training on walking in people with MS. A single blinded randomized parallel group trial was carried out. Eligible participants were adults with MS with Expanded Disability Status Scale score ≤6. A total of 29 participants were randomized and 28 received the allocated exercise intervention, treadmill (n = 13) or strength training (n = 15). Both groups exercised 30 minutes, three times a week for 8 weeks. Primary outcome was The Functional Ambulation Profile evaluated by the GAITRite walkway. Secondary outcomes were walking work economy and balance control during walking, measured by a small lightweight accelerometer connected to the lower back. Testing was performed at baseline and the subsequent week after completion of training. Two participants were lost to follow-up, and 11 (treadmill) and 15 (strength training) were left for analysis. The treadmill group increased their Functional Ambulation Profile score significantly compared with the strength training group (p = .037). A significant improvement in walking work economy (p = .024) and a reduction of root mean square of vertical acceleration (p = .047) also favoured the treadmill group. The results indicate that task-specific training by treadmill walking is a favourable approach compared with strength training to improve walking in persons with mild and moderate MS. Implications for Physiotherapy practice, this study adds knowledge for the decision of optimal treatment approaches in people with MS. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Comparison between treadmill training with rhythmic auditory stimulation and ground walking with rhythmic auditory stimulation on gait ability in chronic stroke patients: A pilot study.

PubMed

Park, Jin; Park, So-yeon; Kim, Yong-wook; Woo, Youngkeun

2015-01-01

Generally, treadmill training is very effective intervention, and rhythmic auditory stimulation is designed to feedback during gait training in stroke patients. The purpose of this study was to compare the gait abilities in chronic stroke patients following either treadmill walking training with rhythmic auditory stimulation (TRAS) or over ground walking training with rhythmic auditory stimulation (ORAS). Nineteen subjects were divided into two groups: a TRAS group (9 subjects) and an ORAS group (10 subjects). Temporal and spatial gait parameters and motor recovery ability were measured before and after the training period. Gait ability was measured by the Biodex Gait trainer treadmill system, Timed up and go test (TUG), 6 meter walking distance (6MWD) and Functional gait assessment (FGA). After the training periods, the TRAS group showed a significant improvement in walking speed, step cycle, step length of the unaffected limb, coefficient of variation, 6MWD, and, FGA when compared to the ORAS group (p <  0.05). Treadmill walking training during the rhythmic auditory stimulation may be useful for rehabilitation of patients with chronic stroke.

How to Find the Right Therapist

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Initial Outcomes from a Multicenter Study Utilizing the Indego Powered Exoskeleton in Spinal Cord Injury.

PubMed

Tefertiller, Candy; Hays, Kaitlin; Jones, Janell; Jayaraman, Arun; Hartigan, Clare; Bushnik, Tamara; Forrest, Gail F

2018-01-01

Objective: To assess safety and mobility outcomes utilizing the Indego powered exoskeleton in indoor and outdoor walking conditions with individuals previously diagnosed with a spinal cord injury (SCI). Methods: We conducted a multicenter prospective observational cohort study in outpatient clinics associated with 5 rehabilitation hospitals. A convenience sample of nonambulatory individuals with SCI ( N = 32) completed an 8-week training protocol consisting of walking training 3 times per week utilizing the Indego powered exoskeleton in indoor and outdoor conditions. Participants were also trained in donning/doffing the exoskeleton during each session. Safety measures such as adverse events (AEs) were monitored and reported. Time and independence with donning/doffing the exoskeleton as well as walking outcomes to include the 10-meter walk test (10MWT), 6-minute walk test (6MWT), Timed Up & Go test (TUG), and 600-meter walk test were evaluated from midpoint to final evaluations. Results: All 32 participants completed the training protocol with limited device-related AEs, which resulted in no interruption in training. The majority of participants in this trial were able to don and doff the Indego independently. Final walking speed ranged from 0.19 to 0.55 m/s. Final average indoor and outdoor walking speeds among all participants were 0.37 m/s ( SD = 0.08, 0.09, respectively), after 8 weeks of training. Significant ( p < .05) improvements were noted between midpoint and final gait speeds in both indoor and outdoor conditions. Average walking endurance also improved among participants after training. Conclusion: The Indego was shown to be safe for providing upright mobility to 32 individuals with SCIs who were nonambulatory. Improvements in speed and independence were noted with walking in indoor and outdoor conditions as well as with donning/doffing the exoskeleton.

Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial.

PubMed

Eich, H-J; Mach, H; Werner, C; Hesse, S

2004-09-01

To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone. Randomized controlled trial. Rehabilitation unit. Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0-100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B. Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax-HRrest)*0.6+HRrest; in group B 60 min of daily physiotherapy for six weeks. Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity (m), secondary were gross motor function including walking ability (score out of 13) and walking quality (score out of 41), blindly assessed before and after the intervention, and at follow-up three months later. Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p =0.001 versus p =0.002) and at follow-up (p <0.001 versus p <0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time. Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.

Best facilitated cortical activation during different stepping, treadmill, and robot-assisted walking training paradigms and speeds: A functional near-infrared spectroscopy neuroimaging study.

PubMed

Kim, Ha Yeon; Yang, Sung Phil; Park, Gyu Lee; Kim, Eun Joo; You, Joshua Sung Hyun

2016-01-01

Robot-assisted and treadmill-gait training are promising neurorehabilitation techniques, with advantages over conventional gait training, but the neural substrates underpinning locomotor control remain unknown particularly during different gait training modes and speeds. The present optical imaging study compared cortical activities during conventional stepping walking (SW), treadmill walking (TW), and robot-assisted walking (RW) at different speeds. Fourteen healthy subjects (6 women, mean age 30.06, years ± 4.53) completed three walking training modes (SW, TW, and RW) at various speeds (self-selected, 1.5, 2.0, 2.5, and 3.0  km/h). A functional near-infrared spectroscopy (fNIRS) system determined cerebral hemodynamic changes associated with cortical locomotor network areas in the primary sensorimotor cortex (SMC), premotor cortex (PMC), supplementary motor area (SMA), prefrontal cortex (PFC), and sensory association cortex (SAC). There was increased cortical activation in the SMC, PMC, and SMA during different walking training modes. More global locomotor network activation was observed during RW than TW or SW. As walking speed increased, multiple locomotor network activations were observed, and increased activation power spectrum. This is the first empirical evidence highlighting the neural substrates mediating dynamic locomotion for different gait training modes and speeds. Fast, robot-assisted gait training best facilitated cortical activation associated with locomotor control.

Effects of Progressive Body Weight Support Treadmill Forward and Backward Walking Training on Stroke Patients' Affected Side Lower Extremity's Walking Ability.

PubMed

Kim, Kyunghoon; Lee, Sukmin; Lee, Kyoungbo

2014-12-01

[Purpose] The purpose of the present study was to examine the effects of progressive body weight supported treadmill forward and backward walking training (PBWSTFBWT), progressive body weight supported treadmill forward walking training (PBWSTFWT), progressive body weight supported treadmill backward walking training (PBWSTBWT), on stroke patients' affected side lower extremity's walking ability. [Subjects and Methods] A total of 36 chronic stroke patients were divided into three groups with 12 subjects in each group. Each of the groups performed one of the progressive body weight supported treadmill training methods for 30 minute, six times per week for three weeks, and then received general physical therapy without any other intervention until the follow-up tests. For the assessment of the affected side lower extremity's walking ability, step length of the affected side, stance phase of the affected side, swing phase of the affected side, single support of the affected side, and step time of the affected side were measured using optogait and the symmetry index. [Results] In the within group comparisons, all the three groups showed significant differences between before and after the intervention and in the comparison of the three groups, the PBWSTFBWT group showed more significant differences in all of the assessed items than the other two groups. [Conclusion] In the present study progressive body weight supported treadmill training was performed in an environment in which the subjects were actually walked, and PBWSTFBWT was more effective at efficiently training stroke patients' affected side lower extremity's walking ability.

Over ground walking and body weight supported walking improve mobility equally in cerebral palsy: a randomised controlled trial.

PubMed

Swe, Ni Ni; Sendhilnnathan, Sunitha; van Den Berg, Maayken; Barr, Christopher

2015-11-01

To assess partial body weight supported treadmill training versus over ground training for walking ability in children with mild to moderate cerebral palsy. Randomised controlled trial. A Special Needs school in Singapore. Thirty children with cerebral palsy, aged 6-18, with a Gross Motor Function Classification System score of II-III. Two times 30 minute sessions of walking training per week for 8 weeks, progressed as tolerated, either over ground (control) or using partial body weight supported treadmill training (intervention). The 10 metre walk test, and the 6 minute walk test. Secondary measures were sub-sections D and E on the Gross Motor Function Measure. Outcomes were assessed at baseline, and after 4 and 8 weeks of training. There was no effect of group allocation on any outcome measure, while time was a significant factor for all outcomes. Walking speed improved significantly more in the intervention group by week 4 (0.109 (0.067)m/s vs 0.048 (0.071)m/s, P=0.024) however by week 8 the change from baseline was similar (intervention 0.0160 (0.069)m/s vs control 0.173 (0.109)m/s, P=0.697). All gains made by week 4 were significantly improved on by week 8 for the 10 metre walk test, 6 minute walk test, and the gross motor function measure. Partial body weight supported treadmill training is no more effective than over ground walking at improving aspects of walking and function in children with mild to moderate cerebral palsy. Gains seen in 4 weeks can be furthered by 8 weeks. © The Author(s) 2015.

Dynamic control of a moving platform using the CAREN system to optimize walking in virtual reality environments.

PubMed

Makssoud, Hassan El; Richards, Carol L; Comeau, François

2009-01-01

Virtual reality (VR) technology offers the opportunity to expose patients to complex physical environments without physical danger and thus provides a wide range of opportunities for locomotor training or the study of human postural and walking behavior. A VR-based locomotor training system has been developed for gait rehabilitation post-stroke. A clinical study has shown that persons after stroke are able to adapt and benefit from this novel system wherein they walk into virtual environments (VEs) on a self-paced treadmill mounted on a platform with 6 degrees of freedom. This platform is programmed to mimic changes in the terrain encountered in the VEs. While engaging in these VEs, excessive trunk movements and speed alterations have been observed, especially during the pitch perturbations accompanying uphill or downhill terrain changes. An in-depth study of the subject's behavior in relation to the platform movements revealed that the platform rotational axes need to be modified, as previously shown by Barton et al, and in addition did not consider the subject's position on the treadmill. The aim of this study was to determine an optimal solution to simulate walking in real life when engaging in VEs.

Short- and Long-Term Effects of Concurrent Strength and HIIT Training in Octogenarians with COPD.

PubMed

Guadalupe-Grau, Amelia; Aznar-Laín, Susana; Mañas, Asier; Castellanos, Juan; Alcázar, Julián; Ara, Ignacio; Mata, Esmeralda; Daimiel, Rosa; García-García, Francisco José

2017-01-01

To investigate the short- and long-term effects of concurrent strength and high-intensity interval training (HIIT) on octogenarian COPD patients, nine males (age = 84.2 ± 2.8 years, BMI = 29.3 ± 2.3) with low to severe COPD levels (2.1 ± 1.5 BODE index) underwent a supervised 9-week strength and HIIT exercise program. Training had a significant (p < .05) impact on senior fitness test scores (23-45%), 30-m walking speed (from 1.29 ± 0.29-1.62 ± 0.33 m/s), leg and chest press 1RM (38% and 45% respectively), maximal isometric strength (30-35%), and 6-min walking test (from 286.1 ± 107.2-396.2 ± 106.5 m), and tended to increase predicted forced vital capacity by 14% (p = .07). One year after the intervention all training-induced gains returned to their preintervention values except for the chest press 1RM (p <.05). Short-term concurrent strength and HIIT training increases physical fitness in the oldest-old COPD patients, and has potential long-term benefits.

Exercise training in older adults, what effects on muscle oxygenation? A systematic review.

PubMed

Fiogbé, Elie; de Vassimon-Barroso, Verena; de Medeiros Takahashi, Anielle Cristhine

2017-07-01

To determine the effects of different modality of exercise training programs on muscle oxygenation in older adults. Relevant articles were searched in PubMed, Web of Science, Science Direct and Scopus, using the keywords: "Aged" AND "Muscle oxygenation" AND (Exercise OR "Exercise therapy" OR "Exercise Movement Techniques" OR Hydrotherapy), without limitation concerning the publication date. To be included in the full analysis, the study had to be a randomized controlled trial in which older adults participants (mean age: 65 years at least) were submitted to an exercise-training program and muscle oxygenation assessment. The searches resulted in 1238 articles from which 7 met all the inclusion criteria. The trials involved 370 older adults (68.7±1.7years), healthy and with peripheral arterial disease. Studies included resistance and endurance exercises as well as walking sessions. Training sessions were 2-6 time per week, lasted 3-24 months and with different training intensity throughout studies. After a long-term resistance training, healthy older adults showed enhanced muscle oxygen extraction capacity, regulation of vessels and vascular endothelium function; endurance training is reported to improve microvascular blood flow and matching of oxygen delivery to oxygen utilization, muscle oxidative capacity and muscle saturation, and walking sessions results in better muscle oxygen availability and muscle oxygen extraction capacity in older adults with peripheral arterial disease. This review supports the fact that depending on the clinical status of the participants and the modality, exercise training improves different aspects of the muscle oxygenation in older adults. Copyright © 2017 Elsevier B.V. All rights reserved.

Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

PubMed

Paneroni, Mara; Simonelli, Carla; Vitacca, Michele; Ambrosino, Nicolino

2017-08-01

To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD). We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ). Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897-98.927); standardized mean difference, 3.86 (95% CI, 2.04-5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, -8.041 (95% CI, -15.273 to -0.809); standardized mean difference, -1.23 (95% CI, -2.14 to -0.31)]. Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed.

Training Enhances Both Locomotor and Cognitive Adaptability to a Novel Sensory Environment

NASA Technical Reports Server (NTRS)

Bloomberg, J. J.; Peters, B. T.; Mulavara, A. P.; Brady, R. A.; Batson, C. D.; Ploutz-Snyder, R. J.; Cohen, H. S.

2010-01-01

During adaptation to novel gravitational environments, sensorimotor disturbances have the potential to disrupt the ability of astronauts to perform required mission tasks. The goal of this project is to develop a sensorimotor adaptability (SA) training program to facilitate rapid adaptation. We have developed a unique training system comprised of a treadmill placed on a motion-base facing a virtual visual scene that provides an unstable walking surface combined with incongruent visual flow designed to enhance sensorimotor adaptability. The goal of our present study was to determine if SA training improved both the locomotor and cognitive responses to a novel sensory environment and to quantify the extent to which training would be retained. Methods: Twenty subjects (10 training, 10 control) completed three, 30-minute training sessions during which they walked on the treadmill while receiving discordant support surface and visual input. Control subjects walked on the treadmill but did not receive any support surface or visual alterations. To determine the efficacy of training all subjects performed the Transfer Test upon completion of training. For this test, subjects were exposed to novel visual flow and support surface movement, not previously experienced during training. The Transfer Test was performed 20 minutes, 1 week, 1, 3 and 6 months after the final training session. Stride frequency, auditory reaction time, and heart rate data were collected as measures of postural stability, cognitive effort and anxiety, respectively. Results: Using mixed effects regression methods we determined that subjects who received SA training showed less alterations in stride frequency, auditory reaction time and heart rate compared to controls. Conclusion: Subjects who received SA training improved performance across a number of modalities including enhanced locomotor function, increased multi-tasking capability and reduced anxiety during adaptation to novel discordant sensory information. Trained subjects maintained their level of performance over six months.

Locomotor Training and Strength and Balance Exercises for Walking Recovery After Stroke: Response to Number of Training Sessions.

PubMed

Rose, Dorian K; Nadeau, Stephen E; Wu, Samuel S; Tilson, Julie K; Dobkin, Bruce H; Pei, Qinglin; Duncan, Pamela W

2017-11-01

Evidence-based guidelines are needed to inform rehabilitation practice, including the effect of number of exercise training sessions on recovery of walking ability after stroke. The objective of this study was to determine the response to increasing number of training sessions of 2 interventions-locomotor training and strength and balance exercises-on poststroke walking recovery. This is a secondary analysis of the Locomotor Experience Applied Post-Stroke (LEAPS) randomized controlled trial. Six rehabilitation sites in California and Florida and participants' homes were used. Participants were adults who dwelled in the community (N=347), had had a stroke, were able to walk at least 3 m (10 ft) with assistance, and had completed the required number of intervention sessions. Participants received 36 sessions (3 times per week for 12 weeks), 90 minutes in duration, of locomotor training (gait training on a treadmill with body-weight support and overground training) or strength and balance training. Talking speed, as measured by the 10-Meter Walk Test, and 6-minute walking distance were assessed before training and following 12, 24, and 36 intervention sessions. Participants at 2 and 6 months after stroke gained in gait speed and walking endurance after up to 36 sessions of treatment, but the rate of gain diminished steadily and, on average, was very low during the 25- to 36-session epoch, regardless of treatment type or severity of impairment. Results may not generalize to people who are unable to initiate a step at 2 months after stroke or people with severe cardiac disease. In general, people who dwelled in the community showed improvements in gait speed and walking distance with up to 36 sessions of locomotor training or strength and balance exercises at both 2 and 6 months after stroke. However, gains beyond 24 sessions tended to be very modest. The tracking of individual response trajectories is imperative in planning treatment. Published by Oxford University Press on behalf of American Physical Therapy Association 2017.

Comparison of forward versus backward walking using body weight supported treadmill training in an individual with a spinal cord injury: a single subject design.

PubMed

Moriello, Gabriele; Pathare, Neeti; Cirone, Cono; Pastore, Danielle; Shears, Dacia; Sulehri, Sahira

2014-01-01

Body weight supported treadmill training (BWSTT) is a task-specific intervention that promotes functional locomotion. There is no research evaluating the effect of backward walking (BW) using BWSTT in individuals with spinal cord injury (SCI). The purpose of this single subject design was to examine the differences between forward walking (FW) and BW training using BWSTT in an individual with quadriparesis. The participant was a 57-year-old male with incomplete C3-C6 SCI. An ABABAB design (A = BW; B = FW; each phase = 3 weeks of biweekly sessions) was utilized. Outcome measures included: gait parameters; a timed 4-meter walk; the 5-repetition sit-to-stand test (STST); tandem stance time; and 6-minute walk test (6MWT). Data was analyzed with split level method of trend estimation. Improvements in gait parameters, on the timed 4-meter walk, 6MWT, tandem balance and aerobic endurance were similar with FW and BW training. The only difference between FW and BW training was that BW training resulted in greater improvements in the STST. The results of this study suggest that in this individual backward walking training was advantageous, resulting in improved ability to perform the 5-repetition STST. It is suspected that these changes can be attributed to the differences in muscle activation and task difficulty between FW and BW.

Training Modalities to Increase Sensorimotor Adaptability

NASA Technical Reports Server (NTRS)

Bloomberg, J. J.; Mulavara, A. P.; Peters, B. T.; Brady, R.; Audas, C.; Cohen, H. S.

2009-01-01

During the acute phase of adaptation to novel gravitational environments, sensorimotor disturbances have the potential to disrupt the ability of astronauts to perform required mission tasks. The goal of our current series of studies is develop a sensorimotor adaptability (SA) training program designed to facilitate recovery of functional capabilities when astronauts transition to different gravitational environments. The project has conducted a series of studies investigating the efficacy of treadmill training combined with a variety of sensory challenges (incongruent visual input, support surface instability) designed to increase adaptability. SA training using a treadmill combined with exposure to altered visual input was effective in producing increased adaptability in a more complex over-ground ambulatory task on an obstacle course. This confirms that for a complex task like walking, treadmill training contains enough of the critical features of overground walking to be an effective training modality. SA training can be optimized by using a periodized training schedule. Test sessions that each contain short-duration exposures to multiple perturbation stimuli allows subjects to acquire a greater ability to rapidly reorganize appropriate response strategies when encountering a novel sensory environment. Using a treadmill mounted on top of a six degree-of-freedom motion base platform we investigated locomotor training responses produced by subjects introduced to a dynamic walking surface combined with alterations in visual flow. Subjects who received this training had improved locomotor performance and faster reaction times when exposed to the novel sensory stimuli compared to control subjects. Results also demonstrate that individual sensory biases (i.e. increased visual dependency) can predict adaptive responses to novel sensory environments suggesting that individual training prescription can be developed to enhance adaptability. These data indicate that SA training can be effectively integrated with treadmill exercise and optimized to provide a unique system that combines multiple training requirements in a single countermeasure system. Learning Objectives: The development of a new countermeasure approach that enhances sensorimotor adaptability will be discussed.

Walking impairment in patients with multiple sclerosis: exercise training as a treatment option.

PubMed

Motl, Robert W; Goldman, Myla D; Benedict, Ralph H B

2010-11-16

Multiple sclerosis (MS) is a chronic disease of the central nervous system that culminates in the progression of physical and cognitive disability over time. Walking impairment is a ubiquitous feature of MS and a sentinel characteristic of the later or advanced stages of the disease. This paper presents a conceptual rationale along with empirical evidence for exercise training as a rehabilitation approach for managing walking impairment and improving walking function in persons with MS. Conceptually, MS is associated with a decrease in physical activity, which, in turn, can result in deconditioning across multiple domains of physiological functioning. The resulting deconditioning feeds back and further drives physical inactivity until a threshold is reached that likely initiates the progression of walking impairment in MS. Empirically, physical activity and exercise training have been associated with beneficial effects on walking function in persons with MS. This is based on cross-sectional, longitudinal, and experimental research that included diversity in the breadth of measures of walking, persons with MS, and exercise/physical activity characteristics. Of particular importance, future researchers might consider examining the combinatory effects of exercise training plus pharmacological agents on walking mobility in MS. Collectively, exercise training and physical activity might hold significant potential for the management of progressive mobility disability in MS.

A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial.

PubMed

Imam, Bita; Miller, William C; Finlayson, Heather C; Eng, Janice J; Payne, Michael Wc; Jarus, Tal; Goldsmith, Charles H; Mitchell, Ian M

2014-12-22

The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed "Wii.n.Walk", an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants' homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks' duration. The primary outcome measure will be the "Two-Minute Walk Test" to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP).

Exercise Training and Cognitive Rehabilitation: A Symbiotic Approach for Rehabilitating Walking and Cognitive Functions in Multiple Sclerosis?

PubMed

Motl, Robert W; Sandroff, Brian M; DeLuca, John

2016-07-01

The current review develops a rationale and framework for examining the independent and combined effects of exercise training and cognitive rehabilitation on walking and cognitive functions in persons with multiple sclerosis (MS). To do so, we first review evidence for improvements in walking and cognitive outcomes with exercise training and cognitive rehabilitation in MS. We then review evidence regarding cognitive-motor coupling and possible cross-modality transfer effects of exercise training and cognitive rehabilitation. We lastly present a macro-level framework for considering mechanisms that might explain improvements in walking and cognitive dysfunction with exercise and cognitive rehabilitation individually and combined in MS. We conclude that researchers should consider examining the effects of exercise training and cognitive rehabilitation on walking, cognition, and cognitive-motor interactions in MS and the possible physiological and central mechanisms for improving these functions. © The Author(s) 2015.

The effects of 2 weeks of interval vs continuous walking training on glycaemic control and whole-body oxidative stress in individuals with type 2 diabetes: a controlled, randomised, crossover trial.

PubMed

Karstoft, Kristian; Clark, Margaret A; Jakobsen, Ida; Müller, Ida A; Pedersen, Bente K; Solomon, Thomas P J; Ried-Larsen, Mathias

2017-03-01

The aim of this study was to evaluate the effects of oxygen consumption-matched short-term interval walking training (IWT) vs continuous walking training (CWT) on glycaemic control, including glycaemic variability, in individuals with type 2 diabetes. We also assessed whether any training-induced improvements in glycaemic control were associated with systemic oxidative stress levels. Participants (n = 14) with type 2 diabetes completed a crossover trial using three interventions (control intervention [CON], CWT and IWT), each lasting 2 weeks. These were performed in a randomised order (computerised generated randomisation) and separated by washout periods of 4 or 8 weeks after CON or training interventions, respectively. Training included ten supervised treadmill sessions, lasting 60 min/session, and was performed at the research facility. CWT was performed at moderate walking speed (75.6% ± 2.5% of walking peak oxygen consumption [[Formula: see text

Slow walking model for children with multiple disabilities via an application of humanoid robot

NASA Astrophysics Data System (ADS)

Wang, ZeFeng; Peyrodie, Laurent; Cao, Hua; Agnani, Olivier; Watelain, Eric; Wang, HaoPing

2016-02-01

Walk training research with children having multiple disabilities is presented. Orthosis aid in walking for children with multiple disabilities such as Cerebral Palsy continues to be a clinical and technological challenge. In order to reduce pain and improve treatment strategies, an intermediate structure - humanoid robot NAO - is proposed as an assay platform to study walking training models, to be transferred to future special exoskeletons for children. A suitable and stable walking model is proposed for walk training. It would be simulated and tested on NAO. This comparative study of zero moment point (ZMP) supports polygons and energy consumption validates the model as more stable than the conventional NAO. Accordingly direction variation of the center of mass and the slopes of linear regression knee/ankle angles, the Slow Walk model faithfully emulates the gait pattern of children.

Whole-Body Vibration Training During a Low Frequency Outpatient Exercise Training Program in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Trial

PubMed Central

Spielmanns, Marc; Gloeckl, Rainer; Gropp, Jana Marie; Nell, Christoph; Koczulla, Andreas Rembert; Boeselt, Tobias; Storre, Jan Hendrik; Windisch, Wolfram

2017-01-01

Background The aim of the study was to investigate whether whole-body vibration training (WBVT) can be applied beneficially within an outpatient low frequency exercise program. Methods In a prospective, controlled, randomized study, WBVT effectiveness and safety were investigated in COPD stage II-IV patients undergoing a 3-month training program. Participants took part in a 90-min circuit training once a week. On top patients were randomized to either perform squats with WBVT, or without (conventional training group (CTG)). Before and after the intervention, a sit-to-stand test (STST), a 6-min walk test (6-MWT), the COPD assessment test (CAT), and the chronic respiratory disease questionnaire (CRQ) were evaluated. Results Twenty-eight out of 55 patients completed the study (n = 12 WBTV, n = 16 CTG). The STST time remained nearly constant for the CTG (Δ -0.8 ± 3.1 s) and the WBVT (Δ 1.4 ± 3.2 s; P = 0.227), respectively. Similarly, for both WBVT and CTG, the 6-min walk distance remained unchanged (Δ 7 ± 55 m vs. 9 ± 45 m, P = 0.961). In three out of four categories, the CRQ scores showed a significant improvement within WBVT, and in one category when comparing across groups. The CAT score dropped by -0.8 ± 2.9 points within CTG and by 2.4 ± 2.7 points within WBVT (P = 0.105). There were no adverse events related to WBVT. Conclusion The implementation of WBVT in the context of an outpatient low frequency exercise program did not significantly improve the patients’ exercise capacity. An improvement in CAT and partially in CRQ was shown within WBVT. However, regarding the high dropout rate (49%), these results must be interpreted with caution. PMID:28392859

Effects of Functional Mobility Skills Training for Adults with Severe Multiple Disabilities

ERIC Educational Resources Information Center

Whinnery, Stacie B.; Whinnery, Keith W.

2011-01-01

This study investigated the effects of a functional mobility program on the functional standing and walking skills of five adults with developmental disabilities. The Mobility Opportunities Via Education (MOVE) Curriculum was implemented using a multiple-baseline across subjects design. Repeated measures were taken during baseline, intervention…

Effects of 12-week supervised treadmill training on spatio-temporal gait parameters in patients with claudication.

PubMed

Konik, Anita; Kuklewicz, Stanisław; Rosłoniec, Ewelina; Zając, Marcin; Spannbauer, Anna; Nowobilski, Roman; Mika, Piotr

2016-01-01

The purpose of the study was to evaluate selected temporal and spatial gait parameters in patients with intermittent claudication after completion of 12-week supervised treadmill walking training. The study included 36 patients (26 males and 10 females) aged: mean 64 (SD 7.7) with intermittent claudication. All patients were tested on treadmill (Gait Trainer, Biodex). Before the programme and after its completion, the following gait biomechanical parameters were tested: step length (cm), step cycle (cycle/s), leg support time (%), coefficient of step variation (%) as well as pain-free walking time (PFWT) and maximal walking time (MWT) were measured. Training was conducted in accordance with the current TASC II guidelines. After 12 weeks of training, patients showed significant change in gait biomechanics consisting in decreased frequency of step cycle (p < 0.05) and extended step length (p < 0.05). PFWT increased by 96% (p < 0.05). MWT increased by 100% (p < 0.05). After completing the training, patients' gait was more regular, which was expressed via statistically significant decrease of coefficient of variation (p < 0.05) for both legs. No statistically significant relation between the post-training improvement of PFWT and MWT and step length increase and decreased frequency of step cycle was observed (p > 0.05). Twelve-week treadmill walking training programme may lead to significant improvement of temporal and spatial gait parameters in patients with intermittent claudication. Twelve-week treadmill walking training programme may lead to significant improvement of pain-free walking time and maximum walking time in patients with intermittent claudication.

Effect of a 4-week Nordic walking training on the physical fitness and self-assessment of the quality of health of women of the perimenopausal age.

PubMed

Saulicz, Mariola; Saulicz, Edward; Myśliwiec, Andrzej; Wolny, Tomasz; Linek, Paweł; Knapik, Andrzej; Rottermund, Jerzy

2015-06-01

To determine the effect of a 4-week Nordic walking training on the physical fitness of women of the perimenopausal age and self-assessment of the quality of their health. Eighty-four women between 48 and 58 years of age were included in the study. Half of the group (42) was assigned to the control group and the other half was assigned to the experimental group. In both groups studied, physical fitness was evaluated using a modified Fullerton's test and a quality of life self-assessment SF-36 (Short Form of Health Status Questionnaire). Similar tests were repeated 4 weeks later. In the experimental group, a Nordic walking training was conducted between the two tests. During 4 weeks, 10 training sessions were performed, each session was 60 minutes long, and there was an interval of 2 days between the sessions. A 4-week Nordic walking training resulted in a significant improvement (p < 0.001) of physical fitness as demonstrated by an increased strength and flexibility of the upper and lower part of the body and the ability to walk a longer distance during a 6-minute walking test. Women participating in the training also showed a significant improvement in health in terms of both physical health (p < 0.001) and mental health (p < 0.001). A 4-week Nordic walking training has a positive effect on the physical fitness of the women in the perimenopausal age. Participation in training contributes also to a clearly higher self-assessment of the quality of health.

Effects of modified Pilates on variability of inter-joint coordination during walking in the elderly.

PubMed

Yoon, Sukhoon; Kim, Joo Nyeon; Lim, Hee Sung

2016-12-01

[Purpose] This study aimed to examine the effects of an 8-week modified Pilates program on the variability of inter-joint coordination in the elderly during walking. [Subjects and Methods] Twenty elderly participants with no recent history of orthopedic abnormalities (age, 67.9 ± 2.7 years; height, 163.7 ± 8.9 cm; weight, 67.1 ± 11.6 kg) were recruited for this study and randomly allocated to a modified Pilates exercise group or a control group. Three-dimensional motion analysis was performed on both groups to evaluate the effects of the Pilates exercise. [Results] There was no significant difference in the joint variability of the ankle, knee, and hip joints between the groups, both before training and after training. However, there was a significant increase in the hip-knee deviation phase value in the exercise group after the program was completed, and this increase was also significant when compared with that in the control group. [Conclusion] This study has demonstrated that an 8-week modified Pilates exercise program can have a positive impact on the gait of elderly participants, potentially by enhancing neuromuscular adjustment, which may have positive implications for reducing their fall risk.

Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial

PubMed Central

Scott, William; York, Henry; Theyagaraj, Melita; Price-Miller, Naomi; McQuaid, Jean; Eyvazzadeh, Megan; Ivey, Frederick M.; Macko, Richard F.

2016-01-01

Objective To assess the effectiveness of robotically assisted body weight supported treadmill training (RABWSTT) for improving cardiovascular fitness in chronic motor incomplete spinal cord injury (CMISCI). Design Pilot prospective randomized, controlled clinical trial. Setting Outpatient rehabilitation specialty hospital. Participants Eighteen individuals with CMISCI with American Spinal Injury Association (ASIA) level between C4 and L2 and at least one-year post injury. Interventions CMISCI participants were randomized to RABWSTT or a home stretching program (HSP) three times per week for three months. Those in the home stretching group were crossed over to three months of RABWSTT following completion of the initial three month phase. Outcome measures Peak oxygen consumption (peak VO2) was measured during both robotic treadmill walking and arm cycle ergometry: twice at baseline, once at six weeks (mid-training) and twice at three months (post-training). Peak VO2 values were normalized for body mass. Results The RABWSTT group improved peak VO2 by 12.3% during robotic treadmill walking (20.2 ± 7.4 to 22.7 ± 7.5 ml/kg/min, P = 0.018), compared to a non-significant 3.9% within group change observed in HSP controls (P = 0.37). Neither group displayed a significant change in peak VO2 during arm cycle ergometry (RABWSTT, 8.5% (P = 0.25); HSP, 1.76% (P = 0.72)). A repeated measures analysis showed statistically significant differences between treatments for peak VO2 during both robotic treadmill walking (P = 0.002) and arm cycle ergometry (P = 0.001). Conclusion RABWSTT is an effective intervention model for improving peak fitness levels assessed during robotic treadmill walking in persons with CMISCI. PMID:25520035

CF Training for Moral and Ethical Decision Making in an Operational Context

DTIC Science & Technology

2006-08-16

operational experience and providing strong mentorship; evaluating and promoting individuals who consistently demonstrate high ethical conduct...they can gain first-hand operational experience. As one SME stated, “program planners need to walk a mile in soldier’s shoes . That will make them a...understanding of how their work can more effectively contribute to actual CF performance , and will provide program development efforts with the gravity of

The efficacy of treadmill training with and without projected visual context for improving walking ability and reducing fall incidence and fear of falling in older adults with fall-related hip fracture: a randomized controlled trial.

PubMed

van Ooijen, Mariëlle W; Roerdink, Melvyn; Trekop, Marga; Janssen, Thomas W J; Beek, Peter J

2016-12-28

The ability to adjust walking to environmental context is often reduced in older adults and, partly as result of this, falls are common in this population. A treadmill with visual context projected on its belt (e.g., obstacles and targets) allows for practicing step adjustments relative to that context, while concurrently exploiting the great amount of walking practice associated with conventional treadmill training. The present study was conducted to compare the efficacy of adaptability treadmill training, conventional treadmill training and usual physical therapy in improving walking ability and reducing fear of falling and fall incidence in older adults during rehabilitation from a fall-related hip fracture. In this parallel-group, open randomized controlled trial, seventy older adults with a recent fall-related hip fracture (83.3 ± 6.7 years, mean ± standard deviation) were recruited from inpatient rehabilitation care and block randomized to six weeks inpatient adaptability treadmill training (n = 24), conventional treadmill training (n = 23) or usual physical therapy (n = 23). Group allocation was only blind for assessors. Measures related to walking ability were assessed as the primary outcome before and after the intervention and at 4-week and 12-month follow-up. Secondary outcomes included general health, fear of falling, fall rate and proportion of fallers. Measures of general walking ability, general health and fear of falling improved significantly over time. Significant differences among the three intervention groups were only found for the Functional Ambulation Category and the dual-task effect on walking speed, which were in favor of respectively conventional treadmill training and adaptability treadmill training. Overall, adaptability treadmill training, conventional treadmill training and usual physical therapy resulted in similar effects on walking ability, fear of falling and fall incidence in older adults rehabilitating from a fall-related hip fracture. Additional post hoc subgroup analyses, with stratification for pre-fracture tolerated walking distance and executive function, revealed several intervention effects in favor of adaptability and conventional treadmill training, indicating superiority over usual physical therapy for certain subgroups. Future well-powered studies are necessary to univocally identify the characteristics of individuals who will benefit most from a particular intervention. The Netherlands Trial Register ( NTR3222 , 3 January 2012).

Potential contributions of training intensity on locomotor performance in individuals with chronic stroke.

PubMed

Holleran, Carey L; Rodriguez, Kelly S; Echauz, Anthony; Leech, Kristan A; Hornby, T George

2015-04-01

Many interventions can improve walking ability of individuals with stroke, although the training parameters that maximize recovery are not clear. For example, the contribution of training intensity has not been well established and may contribute to the efficacy of many locomotor interventions. The purpose of this preliminary study was to evaluate the effects of locomotor training intensity on walking outcomes in individuals with gait deficits poststroke. Using a randomized cross-over design, 12 participants with chronic stroke (>6-month duration) performed either high-intensity (70%-80% of heart rate reserve; n = 6) or low-intensity (30%-40% heart rate reserve; n = 6) locomotor training for 12 or fewer sessions over 4 to 5 weeks. Four weeks following completion, the alternate training intervention was performed. Training intensity was manipulated by adding loads or applying resistance during walking, with similar speeds, durations, and amount of stepping practice between conditions. Greater increases in 6-Minute Walk Test performance were observed following high-intensity training compared with low-intensity training. A significant interaction of intensity and order was also observed for 6-Minute Walk Test and peak treadmill speed, with the largest changes in those who performed high-intensity training first. Moderate correlations were observed between locomotor outcomes and measures of training intensity. This study provides the first evidence that the intensity of locomotor practice may be an important independent determinant of walking outcomes poststroke. In the clinical setting, the intensity of locomotor training can be manipulated in many ways, although this represents only 1 parameter to consider.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A90).

Robotic Resistance Treadmill Training Improves Locomotor Function in Children With Cerebral Palsy: A Randomized Controlled Pilot Study.

PubMed

Wu, Ming; Kim, Janis; Gaebler-Spira, Deborah J; Schmit, Brian D; Arora, Pooja

2017-11-01

To determine whether applying controlled resistance forces to the legs during the swing phase of gait may improve the efficacy of treadmill training as compared with applying controlled assistance forces in children with cerebral palsy (CP). Randomized controlled study. Research unit of a rehabilitation hospital. Children with spastic CP (N=23; mean age, 10.6y; range, 6-14y; Gross Motor Function Classification System levels, I-IV). Participants were randomly assigned to receive controlled assistance (n=11) or resistance (n=12) loads applied to the legs at the ankle. Participants underwent robotic treadmill training 3 times a week for 6 weeks (18 sessions). A controlled swing assistance/resistance load was applied to both legs starting from the toe-off to mid-swing phase of gait during training. Outcome measures consisted of overground walking speed, 6-minute walk distance, and Gross Motor Function Measure scores and were assessed pre and post 6 weeks of training and 8 weeks after the end of training. After 6 weeks of treadmill training in participants from the resistance training group, fast walking speed and 6-minute walk distance significantly improved (18% and 30% increases, respectively), and 6-minute walk distance was still significantly greater than that at baseline (35% increase) 8 weeks after the end of training. In contrast, overground gait speed and 6-minute walk distance had no significant changes after robotic assistance training. The results of the present study indicated that robotic resistance treadmill training is more effective than assistance training in improving locomotor function in children with CP. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A Challenge-Based Approach to Body Weight-Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial.

PubMed

Naidu, Avantika; Brown, David; Roth, Elliot

2018-05-03

Body weight support treadmill training protocols in conjunction with other modalities are commonly used to improve poststroke balance and walking function. However, typical body weight support paradigms tend to use consistently stable balance conditions, often with handrail support and or manual assistance. In this paper, we describe our study protocol, which involved 2 unique body weight support treadmill training paradigms of similar training intensity that integrated dynamic balance challenges to help improve ambulatory function post stroke. The first paradigm emphasized walking without any handrails or manual assistance, that is, hands-free walking, and served as the control group, whereas the second paradigm incorporated practicing 9 essential challenging mobility skills, akin to environmental barriers encountered during community ambulation along with hands-free walking (ie hands-free + challenge walking). We recruited individuals with chronic poststroke hemiparesis and randomized them to either group. Participants trained for 6 weeks on a self-driven, robotic treadmill interface that provided body weight support and a safe gait-training environment. We assessed participants at pre-, mid- and post 6 weeks of intervention-training, with a 6-month follow-up. We hypothesized greater walking improvements in the hands-free + challenge walking group following training because of increased practice opportunity of essential mobility skills along with hands-free walking. We assessed 77 individuals with chronic hemiparesis, and enrolled and randomized 30 individuals poststroke for our study (hands-free group=19 and hands-free + challenge walking group=20) from June 2012 to January 2015. Data collection along with 6-month follow-up continued until January 2016. Our primary outcome measure is change in comfortable walking speed from pre to post intervention for each group. We will also assess feasibility, adherence, postintervention efficacy, and changes in various exploratory secondary outcome measures. Additionally, we will also assess participant responses to a study survey, conducted at the end of training week, to gauge each group's training experiences. Our treadmill training paradigms, and study protocol represent advances in standardized approaches to selecting body weight support levels without the necessity for using handrails or manual assistance, while progressively providing dynamic challenges for improving poststroke ambulatory function during rehabilitation. ClinicalTrials.gov NCT02787759; https://clinicaltrials.gov/ct2/show/NCT02787759 (Archived by Webcite at http://www.webcitation.org/6yJZCrIea). ©Avantika Naidu, David Brown, Elliot Roth. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.05.2018.

Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail.

PubMed

Bongartz, Martin; Kiss, Rainer; Ullrich, Phoebe; Eckert, Tobias; Bauer, Jürgen; Hauer, Klaus

2017-09-12

Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI. International Standard Randomized Controlled Trial (# ISRCTN82378327 ). Registered: August 10, 2015.

A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia.

PubMed

Tran, Susan T; Thomas, Staci; DiCesare, Christopher; Pfeiffer, Megan; Sil, Soumitri; Ting, Tracy V; Williams, Sara E; Myer, Gregory D; Kashikar-Zuck, Susmita

2016-07-22

Adolescents with juvenile fibromyalgia (JFM) tend to be very sedentary and avoid participation in physical activity. A prior study suggested that JFM patients show altered biomechanics compared to healthy adolescents which may make them more prone to pain/injury during exercise. A new intervention combining well established cognitive behavioral therapy (CBT) techniques with specialized neuromuscular exercise -Fibromyalgia Integrative Training for Teens (FIT Teens) was developed and shown to be promising in improving functioning in adolescents with JFM. In contrast to traditional exercise programs such as aerobic or resistance training, neuromuscular training is a tailored approach which targets gait, posture, balance and movement mechanics which form the foundation for safe exercise participation with reduced risk for injury or pain (and hence more tolerable by JFM patients). The aim of this pilot feasibility study was to establish whether objective biomechanical assessment including sophisticated 3-D motion analysis would be useful in measuring improvements in strength, balance, gait, and functional performance after participation in the 8-week FIT Teens program. Eleven female participants with JFM (ages 12-18 years) completed pre- and post-treatment assessments of biomechanics, including walking gait analysis, lower extremity strength assessment, functional performance, and dynamic postural stability. Descriptive data indicated that mechanics of walking gait and functional performance appeared to improve after treatment. Hip abduction strength and dynamic postural control also demonstrated improvements bilaterally. Overall, the results of this pilot study offer initial evidence for the utility of biomechanical assessment to objectively demonstrate observable changes in biomechanical performance after an integrated training intervention for youth with JFM. If replicated in larger controlled studies, findings would suggest that through the FIT Teens intervention, adolescents with JFM can progress towards normalized strength and biomechanics, which may enhance their ability to engage in physical exercise.

The Effects of Highly Challenging Balance Training in Elderly With Parkinson's Disease: A Randomized Controlled Trial.

PubMed

Conradsson, David; Löfgren, Niklas; Nero, Håkan; Hagströmer, Maria; Ståhle, Agneta; Lökk, Johan; Franzén, Erika

2015-10-01

Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson's disease (PD); however, its effect on clinical outcomes remains largely unknown. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale-International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects. © The Author(s) 2015.

Outcomes following kinesthetic feedback for gait training in a direct access environment: a case report on social wellness in relation to gait impairment.

PubMed

Blievernicht, Jessica; Sullivan, Kate; Erickson, Mark R

2012-05-01

The purpose of this case report was to describe the outcomes following the use of kinesthetic feedback as a primary intervention strategy for gait training. The plan of care for this 22-year-old female addressed the patient's social wellness goal of "walking more normally," using motor learning principles. At initial examination, the patient demonstrated asymmetries for gait kinematics between the left and right lower extremity (analyzed using video motion analysis), pattern of force distribution at the foot, and activation of specific lower extremity muscles (as measured by surface electromyography). Interventions for this patient consisted of neuromuscular and body awareness training, with an emphasis on kinesthetic feedback. Weekly sessions lasted 30-60 minutes over 4 weeks. The patient was prescribed a home program of walking 30-60 minutes three times/week at a comfortable pace while concentrating on gait correction through kinesthetic awareness of specific deviations. Following intervention, the patient's gait improved across all objective measures. She reported receiving positive comments from others regarding improved gait and a twofold increase in her walking confidence. Outcomes support a broadened scope of practice that incorporates previously unreported integration of a patient's social wellness goals into patient management.

Feasibility of a combined aerobic and strength training program and its effects on cognitive and physical function in institutionalized dementia patients. A pilot study.

PubMed

Bossers, Willem J R; Scherder, Erik J A; Boersma, Froukje; Hortobágyi, Tibor; van der Woude, Lucas H V; van Heuvelen, Marieke J G

2014-01-01

We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function. Thirty-three patients with dementia, recruited from one nursing home, participated in this non-randomized pilot study (25 women; age = 85.2±4.9 years; Mini Mental State Examination = 16.8±4.0). In phase 1 of the study, seventeen patients in the Exercise group (EG) received a combined aerobic and strength training program for six weeks, five times per week, 30 minutes per session, in an individually supervised format and successfully concluded the pre and posttests. In phase 2 of the study, sixteen patients in the Social group (SG) received social visits at the same frequency, duration, and format and successfully concluded the pre and posttests. Indices of feasibility showed that the recruitment and adherence rate, respectively were 46.2% and 86.3%. All EG patients completed the exercise program according to protocol without adverse events. After the six-week program, no significant differences on cognitive function tests were found between the EG and SG. There was a moderate effect size in favor for the EG for the Visual Memory Span Forward; a visual attention test. There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed (p = .003), Six-Minute Walk Test (p = .031), and isometric quadriceps strength (p = .012). The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia. The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large randomized clinical trials. trialregister.nl 1230.

Randomized Controlled Trial of a Home-Based Action Observation Intervention to Improve Walking in Parkinson Disease.

PubMed

Jaywant, Abhishek; Ellis, Terry D; Roy, Serge; Lin, Cheng-Chieh; Neargarder, Sandy; Cronin-Golomb, Alice

2016-05-01

To examine the feasibility and efficacy of a home-based gait observation intervention for improving walking in Parkinson disease (PD). Participants were randomly assigned to an intervention or control condition. A baseline walking assessment, a training period at home, and a posttraining assessment were conducted. The laboratory and participants' home and community environments. Nondemented individuals with PD (N=23) experiencing walking difficulty. In the gait observation (intervention) condition, participants viewed videos of healthy and parkinsonian gait. In the landscape observation (control) condition, participants viewed videos of moving water. These tasks were completed daily for 8 days. Spatiotemporal walking variables were assessed using accelerometers in the laboratory (baseline and posttraining assessments) and continuously at home during the training period. Variables included daily activity, walking speed, stride length, stride frequency, leg swing time, and gait asymmetry. Questionnaires including the 39-item Parkinson Disease Questionnaire (PDQ-39) were administered to determine self-reported change in walking, as well as feasibility. At posttraining assessment, only the gait observation group reported significantly improved mobility (PDQ-39). No improvements were seen in accelerometer-derived walking data. Participants found the at-home training tasks and accelerometer feasible to use. Participants found procedures feasible and reported improved mobility, suggesting that observational training holds promise in the rehabilitation of walking in PD. Observational training alone, however, may not be sufficient to enhance walking in PD. A more challenging and adaptive task, and the use of explicit perceptual learning and practice of actions, may be required to effect change. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Body weight-supported gait training for restoration of walking in people with an incomplete spinal cord injury: a systematic review.

PubMed

Wessels, Monique; Lucas, Cees; Eriks, Inge; de Groot, Sonja

2010-06-01

To evaluate the effect of body weight-supported gait training on restoration of walking, activities of daily living, and quality of life in persons with an incomplete spinal cord injury by a systematic review of the literature. Cochrane, MEDLINE, EMBASE, CINAHL, PEDro, DocOnline were searched and identified studies were assessed for eligibility and methodological quality and described regarding population, training protocol, and effects on walking ability, activities of daily living and quality of life. A descriptive and quantitative synthesis was conducted. Eighteen articles (17 studies) were included. Two randomized controlled trials showed that subjects with injuries of less than one year duration reached higher scores on the locomotor item of the Functional Independence Measure (range 1-7) in the over-ground training group compared with the body weight-supported treadmill training group. Only for persons with an American Spinal Injury Association Impairment Scale C or D was the mean difference significant, with 0.80 (95% confidence interval 0.04-1.56). No differences were found regarding walking velocity, activities of daily living or quality of life. Subjects with subacute motor incomplete spinal cord injury reached a higher level of independent walking after over-ground training, compared with body weight-supported treadmill training. More randomized controlled trials are needed to clarify the effectiveness of body weight-supported gait training on walking, activities of daily living, and quality of life for subgroups of persons with an incomplete spinal cord injury.

Effects of Oxygen Supply During Training on Subjects With COPD Who Are Normoxemic at Rest and During Exercise: A Blinded Randomized Controlled Trial.

PubMed

Spielmanns, Marc; Fuchs-Bergsma, Chantal; Winkler, Aurelia; Fox, Gabriele; Krüger, Stefan; Baum, Klaus

2015-04-01

It is well established that physical training enhances functionality and quality of life in patients with COPD. However, little data exist concerning the effects of the usefulness of oxygen supply during exercise training for > 3 months in patients with COPD who are normoxemic at rest and during exercise. We hypothesized that oxygen supply during training sessions enables higher training intensity and thus optimizes training results in patients with COPD. In this blinded randomized controlled study, we carried out a 24-week training program with progressively increasing loads involving large muscle groups. In addition, we compared the influences of oxygen supplementation. Thirty-six subjects with moderate-to-severe COPD who were not dependent on long-term oxygen therapy trained under supervision for 24 weeks (3 times/week at 30 min/session). Subjects were randomized into 2 groups: oxygen supply via nasal cannula at a flow of 4 L/min and compressed air at the same flow throughout the training program. Lung function tests at rest (inspiratory vital capacity, FEV1, Tiffeneau index), cycle spiroergometry (peak ventilation, peak oxygen uptake, peak respiratory exchange rate, submaximal and peak lactic acid concentrations), 6-min walk tests, and quality-of-life assessments (Medical Outcomes Study 36-Item Short Form questionnaire) were conducted before and after 12 and 24 weeks. Independent of oxygen supplementation, statistically significant improvements occurred in quality of life, maximal tolerated load during cycling, peak oxygen uptake, and 6-min walk test after 12 weeks of training. Notably, there were no further improvements from 12 to 24 weeks despite progressively increased training loads. Endurance training 3 times/week resulted in significant improvements in quality of life and exercise capacity in subjects with moderate-to-severe COPD within the initial 12 weeks, followed by a stable period over the following 12 weeks with no further benefits of supplemental oxygen. Copyright © 2015 by Daedalus Enterprises.

Train users’ perceptions of walking distance to train station and attributes of paratransit service: understanding their association with decision using paratransit or not towards the train station

NASA Astrophysics Data System (ADS)

Syafriharti, R.; Kombaitan, B.; Kusumantoro, I. P.; Syabri, I.

2018-05-01

Access mode is an important factor in public transport systems. Most of the train users from Cicalengka to Padalarang via Bandung use paratransit as access mode. Access modes under this study are only paratransit and walking. This study aims to explore the relationship between access mode choice to the station and the perception about walking distance to station, perception about attributes of paratransit service quality which consist of accessibility, cheapness, comfortable, swiftness, safety, security and easiness. Of all the variables tested, walking distance to the station is the only variable relating to the mode access choice. So, a person will tend to use paratransit when his/her perception of walking distance to station is relatively far away. While perceptions about the quality of paratransit service can not determine whether a person will choose paratransit or not.

Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial.

PubMed

van het Reve, Eva; de Bruin, Eling D

2014-12-15

Exercise interventions often do not combine physical and cognitive training. However, this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training. A multicenter parallel randomized controlled trial was conducted to compare a motor to a cognitive-motor exercise program. A total of 182 eligible residents of homes-for-the-aged (n = 159) or elderly living in the vicinity of the homes (n = 23) were randomly assigned to either strength-balance (SB) or strength-balance-cognitive (SBC) training. Both groups conducted similar strength-balance training during 12 weeks. SBC additionally absolved computerized cognitive training. Outcomes were dual task costs of walking, physical performance, simple reaction time, executive functions, divided attention, fear of falling and fall rate. Participants were analysed with an intention to treat approach. The 182 participants (mean age ± SD: 81.5 ± 7.3 years) were allocated to either SB (n = 98) or SBC (n = 84). The attrition rate was 14.3%. Interaction effects were observed for dual task costs of step length (preferred walking speed: F(1,174) = 4.94, p = 0.028, η2 = 0.027, fast walking speed: F(1,166) = 6.14, p = 0.009, η2 = 0.040) and dual task costs of the standard deviation of step length (F(1,166) = 6.14, p = 0.014, η2 = 0.036), in favor of SBC. Significant interactions in favor of SBC revealed for in gait initiation (F(1,166) = 9.16, p = 0.003, η2 = 0.052), 'reaction time' (F(1,180) = 5.243, p = 0.023, η² = 0.028) & 'missed answers' (F(1,180) = 11.839, p = 0.001, η² = 0.062) as part of the test for divided attention. Within-group comparison revealed significant improvements in dual task costs of walking (preferred speed; velocity (p = 0.002), step time (p = 0.018), step length (p = 0.028), fast speed; velocity (p < 0.001), step time (p = 0.035), step length (p = 0.001)), simple reaction time (p < 0.001), executive functioning (Trail making test B; p < 0.001), divided attention (p < 0.001), fear of falling (p < 0.001), and fall rate (p < 0.001). Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking, gait initiation, and divided attention. The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls. This trial has been registered under ISRCTN75134517.

Stepping to the Beat: Feasibility and Potential Efficacy of a Home-Based Auditory-Cued Step Training Program in Chronic Stroke.

PubMed

Wright, Rachel L; Brownless, Simone Briony; Pratt, David; Sackley, Catherine M; Wing, Alan M

2017-01-01

Hemiparesis after stroke typically results in a reduced walking speed, an asymmetrical gait pattern and a reduced ability to make gait adjustments. The purpose of this pilot study was to investigate the feasibility and preliminary efficacy of home-based training involving auditory cueing of stepping in place. Twelve community-dwelling participants with chronic hemiparesis completed two 3-week blocks of home-based stepping to music overlaid with an auditory metronome. Tempo of the metronome was increased 5% each week. One 3-week block used a regular metronome, whereas the other 3-week block had phase shift perturbations randomly inserted to cue stepping adjustments. All participants reported that they enjoyed training, with 75% completing all training blocks. No adverse events were reported. Walking speed, Timed Up and Go (TUG) time and Dynamic Gait Index (DGI) scores (median [inter-quartile range]) significantly improved between baseline (speed = 0.61 [0.32, 0.85] m⋅s -1 ; TUG = 20.0 [16.0, 39.9] s; DGI = 14.5 [11.3, 15.8]) and post stepping training (speed = 0.76 [0.39, 1.03] m⋅s -1 ; TUG = 16.3 [13.3, 35.1] s; DGI = 16.0 [14.0, 19.0]) and was maintained at follow-up (speed = 0.75 [0.41, 1.03] m⋅s -1 ; TUG = 16.5 [12.9, 34.1] s; DGI = 16.5 [13.5, 19.8]). This pilot study suggests that auditory-cued stepping conducted at home was feasible and well-tolerated by participants post-stroke, with improvements in walking and functional mobility. No differences were detected between regular and phase-shift training with the metronome at each assessment point.

Robot-aided gait training in an individual with chronic spinal cord injury: a case study.

PubMed

Bishop, Lauri; Stein, Joel; Wong, Christopher Kevin

2012-09-01

Traditional physical therapy is beneficial in restoring mobility in individuals who have sustained spinal cord injury (SCI), but residual limitations often persist. Robotic technologies may offer opportunities for further gains. The purpose of this case study was to document the use and practicality of gait training for an individual with chronic, incomplete SCI with asymmetric lower limb motor deficits using a novel robotic knee orthosis (RKO). The participant was a 22-year-old woman who sustained fractures of the odontoid process and C5-C6 vertebrae from a motor vehicle accident resulting in incomplete SCI with asymmetric tetraparesis, right side more severe than left side. She required supervised assistance with gait and balance tasks, minimal assistance to ascend/descend steps using a handrail, and upper extremity assistance for sit-to-stand tasks. The participant underwent 7 one-hour sessions of mobility training, using a novel RKO. Her primary goal was to increase independence and endurance with mobility. Functional measures included the 6-Minute Walk Test, the Berg Balance Scale, the Timed Up & Go Test, and the 10-Meter Walk Test. Outcomes were assessed and recorded at baseline and on completion of 7 hours of training with the device over a 2-week period. No adverse events occurred. The RKO was well received by both the participant and the treating therapist. The participant demonstrated improvements in the 6-Minute Walk Test and Berg Balance Scale after RKO-training intervention. Outcomes suggest that the use of this device during a physical therapy program for an individual with incomplete SCI is practical and this device may be a useful adjunct to standard training.

Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton.

PubMed

Gagnon, Dany H; Vermette, Martin; Duclos, Cyril; Aubertin-Leheudre, Mylène; Ahmed, Sara; Kairy, Dahlia

2017-12-19

The main objectives of this study were to quantify clients' satisfaction and perception upon completion of a locomotor training program with an overground robotic exoskeleton. A group of 14 wheelchair users with a spinal cord injury, who finished a 6-8-week locomotor training program with the robotic exoskeleton (18 training sessions), were invited to complete a web-based electronic questionnaire. This questionnaire encompassed 41 statements organized around seven key domains: overall satisfaction related to the training program, satisfaction related to the overground robotic exoskeleton, satisfaction related to the program attributes, perceived learnability, perceived health benefits and risks and perceived motivation to engage in physical activity. Each statement was rated using a visual analogue scale ranging from "0 = totally disagree" to "100 = completely agree". Overall, respondents unanimously considered themselves satisfied with the locomotor training program with the robotic exoskeleton (95.7 ± 0.7%) and provided positive feedback about the robotic exoskeleton itself (82.3 ± 6.9%), the attributes of the locomotor training program (84.5 ± 6.9%) and their ability to learn to perform sit-stand transfers and walk with the robotic exoskeleton (79.6 ± 17%). Respondents perceived some health benefits (67.9 ± 16.7%) and have reported no fear of developing secondary complications or of potential risk for themselves linked to the use of the robotic exoskeleton (16.7 ± 8.2%). At the end of the program, respondents felt motivated to engage in a regular physical activity program (91.3 ± 0.1%). This study provides new insights on satisfaction and perceptions of wheelchair users while also confirming the relevance to continue to improve such technologies, and informing the development of future clinical trials. Implications for Rehabilitation All long-term manual wheelchair users with a spinal cord injury who participated in the study are unanimously satisfied upon completion of a 6-8-week locomotor training program with the robotic exoskeleton and would recommend the program to their peers. All long-term manual wheelchair users with a spinal cord injury who participated in the study offered positive feedback about the robotic exoskeleton itself and feel it is easy to learn to perform sit-stand transfers and walk with the robotic exoskeleton. All long-term manual wheelchair users with a spinal cord injury who participated in the study predominantly perceived improvements in their overall health status, upper limb strength and endurance as well as in their sleep and psychological well-being upon completion of a 6-8-week locomotor training program with the robotic exoskeleton. All long-term manual wheelchair users with a spinal cord injury who participated in the study unanimously felt motivated to engage in a regular physical activity program adapted to their condition and most of them do plan to continue to participate in moderate-to-strenuous physical exercise. Additional research on clients' perspectives, especially satisfaction with the overground exoskeleton and locomotor training program attributes, is needed.

Muscle coordination in healthy subjects during floor walking and stair climbing in robot assisted gait training.

PubMed

Hussein, S; Schmidt, H; Volkmar, M; Werner, C; Helmich, I; Piorko, F; Krüger, J; Hesse, S

2008-01-01

The aim of gait rehabilitation is a restoration of an independent gait and improvement of daily life walking functions. Therefore the specific patterns, that are to be relearned, must be practiced to stimulate the learning process of the central nervous system (CNS). The Walking Simulator HapticWalker allows for the training of arbitrary gait trajectories of daily life. To evaluate the quality of the training a total of 9 subjects were investigated during free floor walking and stair climbing and during the same tasks in two different training modes on the HapticWalker: 1) with and 2) without vertical center of mass (CoM) motion. Electromyograms (EMG) of 8 gait relevant muscles were measured and muscle activation was compared for the various training modes. Besides the muscle activation as an indicator for the quality of rehabilitation training the study investigates if a cancellation of the vertical CoM movement by adaption of the footplate trajectory is feasible i.e. the muscle activation patterns for the two training modes on the HapticWalker agree. Results show no significant differences in activation timing between the training modes. This indicates the feasibility of using a passive patient suspension and emulate the vertical CoM motion by trajectory adaption of the footplates. The muscle activation timing during HapticWalker training shows important characteristics observed in physiological free walking though a few differences can still remain.

The effectiveness of Robot-Assisted Gait Training versus conventional therapy on mobility in severely disabled progressIve MultiplE sclerosis patients (RAGTIME): study protocol for a randomized controlled trial.

PubMed

Straudi, Sofia; Manfredini, Fabio; Lamberti, Nicola; Zamboni, Paolo; Bernardi, Francesco; Marchetti, Giovanna; Pinton, Paolo; Bonora, Massimo; Secchiero, Paola; Tisato, Veronica; Volpato, Stefano; Basaglia, Nino

2017-02-27

Gait and mobility impairments affect the quality of life (QoL) of patients with progressive multiple sclerosis (MS). Robot-assisted gait training (RAGT) is an effective rehabilitative treatment but evidence of its superiority compared to other options is lacking. Furthermore, the response to rehabilitation is multidimensional, person-specific and possibly involves functional reorganization processes. The aims of this study are: (1) to test the effectiveness on gait speed, mobility, balance, fatigue and QoL of RAGT compared to conventional therapy (CT) in progressive MS and (2) to explore changes of clinical and circulating biomarkers of neural plasticity. This will be a parallel-group, randomized controlled trial design with the assessor blinded to the group allocation of participants. Ninety-eight (49 per arm) progressive MS patients (EDSS scale 6-7) will be randomly assigned to receive twelve 2-h training sessions over a 4-week period (three sessions/week) of either: (1) RAGT intervention on a robotic-driven gait orthosis (Lokomat, Hocoma, Switzerland). The training parameters (torque of the knee and hip drives, treadmill speed, body weight support) are set during the first session and progressively adjusted during training progression or (2) individual conventional physiotherapy focusing on over-ground walking training performed with the habitual walking device. The same assessors will perform outcome measurements at four time points: baseline (before the first intervention session); intermediate (after six training sessions); end of treatment (after the completion of 12 sessions); and follow-up (after 3 months from the end of the training program). The primary outcome is gait speed, assessed by the Timed 25-Foot Walk Test. We will also assess walking endurance, balance, depression, fatigue and QoL as well as instrumental laboratory markers (muscle metabolism, cerebral venous hemodynamics, cortical activation) and circulating laboratory markers (rare circulating cell populations pro and anti-inflammatory cytokines/chemokines, growth factors, neurotrophic factors, coagulation factors, other plasma proteins suggested by transcriptomic analysis and metabolic parameters). The RAGT training is expected to improve mobility compared to the active control intervention in progressive MS. Unique to this study is the analysis of various potential markers of plasticity in relation with clinical outcomes. ClinicalTrials.gov, identifier: NCT02421731 . Registered on 19 January 2015 (retrospectively registered).

[Effects of exercise training on ergocycle during hemodialysis in patients with end stage renal disease: relevance of the anaerobic threshold intensity].

PubMed

Besnier, Florent; Laruelle, Eric; Genestier, Sandrine; Gié, Sophie; Vigneau, Cécile; Carré, François

2012-07-01

Chronic kidney failure (CRF) in addition to cardiovascular comorbidities and aging decrease physical activity capacity. An adapted rehabilitation program might be strongly recommended in this population. The aim of the study is to evaluate a 3 months exercise training program with ergocycle at the anaerobic threshold (AT) during dialysis sessions on effort tolerance, quality of life, blood pressure and lipidic disorders. Six patients meanly aged 72 were evaluated before (t(0)) and after (t(3)) the rehabilitation program by: maximal cardiorespiratory ergotest, a 6-Minute Walk Test (6MWT) and 2 quality of life tests: Medical Outcome Survey Short Form 36-items and the Kidney Disease Quality of Life (SF 36, KDQol). Physical activity during dialysis is well tolerated. There was no undesirable event during rehabilitation sessions. The dyspnea and muscular weariness threshold linked to the AT increased meanly by 39% (8.83 ± 0.87 vs. 12.25 ± 1.23 mL/min per kg). Distances walked during 6 MWT increased for all patients (351.83 ± 72.17 vs. 412.80 ± 82 meters) Moreover, physical component scale improved (+4.7), mean systolic blood pressure (-7 mmHg) and mean triglycerides concentration (-19%) decreased. An exercise training program during dialysis sessions with ergocycle and working intensity based on AT seems safe and an effective alternative to improve the effort functional capacity by hemodialysis patients. Copyright © 2011 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

The Combined Effects of Body Weight Support and Gait Speed on Gait Related Muscle Activity: A Comparison between Walking in the Lokomat Exoskeleton and Regular Treadmill Walking

PubMed Central

Van Kammen, Klaske; Boonstra, Annemarijke; Reinders-Messelink, Heleen; den Otter, Rob

2014-01-01

Background For the development of specialized training protocols for robot assisted gait training, it is important to understand how the use of exoskeletons alters locomotor task demands, and how the nature and magnitude of these changes depend on training parameters. Therefore, the present study assessed the combined effects of gait speed and body weight support (BWS) on muscle activity, and compared these between treadmill walking and walking in the Lokomat exoskeleton. Methods Ten healthy participants walked on a treadmill and in the Lokomat, with varying levels of BWS (0% and 50% of the participants’ body weight) and gait speed (0.8, 1.8, and 2.8 km/h), while temporal step characteristics and muscle activity from Erector Spinae, Gluteus Medius, Vastus Lateralis, Biceps Femoris, Gastrocnemius Medialis, and Tibialis Anterior muscles were recorded. Results The temporal structure of the stepping pattern was altered when participants walked in the Lokomat or when BWS was provided (i.e. the relative duration of the double support phase was reduced, and the single support phase prolonged), but these differences normalized as gait speed increased. Alternations in muscle activity were characterized by complex interactions between walking conditions and training parameters: Differences between treadmill walking and walking in the exoskeleton were most prominent at low gait speeds, and speed effects were attenuated when BWS was provided. Conclusion Walking in the Lokomat exoskeleton without movement guidance alters the temporal step regulation and the neuromuscular control of walking, although the nature and magnitude of these effects depend on complex interactions with gait speed and BWS. If normative neuromuscular control of gait is targeted during training, it is recommended that very low speeds and high levels of BWS should be avoided when possible. PMID:25226302

Combination of body mass-based resistance training and high-intensity walking can improve both muscle size and V˙O2 peak in untrained older women.

PubMed

Ozaki, Hayao; Kitada, Tomoharu; Nakagata, Takashi; Naito, Hisashi

2017-05-01

Here, we aimed to compare the effect of a combination of body mass-based resistance exercise and moderate-intensity (55% peak oxygen uptake [ V˙O 2 peak]) walking or high-intensity (75% V˙O 2 peak) walking on muscle size and V˙O 2 peak in untrained older women. A total of 12 untrained older women (mean age 60 ± 2 years) were randomly assigned to either a moderate-intensity aerobic training group (n = 6) or high-intensity aerobic training group (n = 6). Both groups carried out body-mass based (lower body) resistance exercises (2 sets of 10 repetitions) on 3 days/week for 8 weeks. Between these exercises, the participants in the moderate-intensity aerobic training group walked at a previously determined speed equivalent to 55% V˙O 2 peak, whereas those in the high-intensity aerobic training group walked at a speed equivalent to 75% V˙O 2 peak. Muscle thickness of the anterior aspect of the thigh and maximal isokinetic knee extension strength significantly increased in both groups (P < 0.01); these relative changes were negatively correlated with the absolute muscle thickness of the anterior aspect of the thigh value and the relative value of maximal knee strength to body mass at pre-intervention, respectively. A significant group × time interaction was noted for V˙O 2 peak (P < 0.05), which increased only in the high-intensity aerobic training group. Body mass-based resistance training significantly induced muscle hypertrophy in untrained older women. In particular, lower muscle thickness before intervention was associated with greater training-induced growth. Furthermore, V˙O 2 peak can be increased by combined circuit training involving low-load resistance exercise and walking, particularly when a relatively high intensity of walking is maintained. Geriatr Gerontol Int 2017; 17: 779-784. © 2016 Japan Geriatrics Society.

Current education versus peer-education on walking in type 2 diabetic patients based on Health Belief Model: a randomized control trial study.

PubMed

Baghianimoghadam, M H; Hadavandkhani, M; Mohammadi, M; Fallahzade, H; Baghianimoghadam, B

2012-01-01

Diabetes is a disease with several metabolic and organic symptoms. Physical activity plays a key role in controlling type 2 diabetes. Several researches confirm that educational strategies can lead to healthy behaviors and its continuation is effective and can indicate what type of relationship with the client is better. The purpose of this study is comparing the Effect of Current Education and Peer-Education on Walking in Type 2 Diabetic Patients based on Health Belief Model (HBM). This was a clinical trial (RCT) study done on 80 people with type 2 diabetes. Patients were divided into two groups, Current education and Peer education groups. Data were collected using a questionnaire based on the health belief model, a checklist related to patients' practice and recording patients' HbA1c, 2HPP and FBS levels. Results were documented before and three months after intervention. The patients participated in 2 educational classes during three months of intervention, as the follow-up of the intervention. Mean scores for HBM Model variables, i.e. perceived susceptibility, perceived severity, perceived benefit and self-efficacy, were significantly increased in the peer education group compared to current education group after intervention. Also, behavioral walking, rates of HbA1c and FBS and 2HPP levels were improved significantly among the peer education group. Applying walking training program developed for diabetic patients and its implementation by the peers in order to control blood sugar using the health belief model is very useful and effective. During implementation of these control programs, monitoring and follow-up training is recommended.

Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial.

PubMed

Hunt, M A; Charlton, J M; Krowchuk, N M; Tse, C T F; Hatfield, G L

2018-04-27

To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis. Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15° more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait. Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference = -9.04° (indicating more toe-out), 95% CI: -11.22°, -6.86°; P < 0.001), late stance KAM (mean difference = -0.26 %BW*ht, 95% CI: -0.39 %BW*ht, -0.12 %BW*ht, P < 0.001) and KAM impulse (-0.06 %BW*ht*s, 95% CI: -0.11 %BW*ht*s, -0.01 %BW*ht*s; P = 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference = -6.78°, 95% CI: -8.82°, -4.75°; P < 0.001). Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements. NCT02019108. Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Changes in Locomotor Muscle Activity After Treadmill Training in Subjects With Incomplete Spinal Cord Injury

PubMed Central

Gorassini, Monica A.; Norton, Jonathan A.; Nevett-Duchcherer, Jennifer; Roy, Francois D.; Yang, Jaynie F.

2009-01-01

Intensive treadmill training after incomplete spinal cord injury can improve functional walking abilities. To determine the changes in muscle activation patterns that are associated with improvements in walking, we measured the electromyography (EMG) of leg muscles in 17 individuals with incomplete spinal cord injury during similar walking conditions both before and after training. Specific differences were observed between subjects that eventually gained functional improvements in overground walking (responders), compared with subjects where treadmill training was ineffective (nonresponders). Although both groups developed a more regular and less clonic EMG pattern on the treadmill, it was only the tibialis anterior and hamstring muscles in the responders that displayed increases in EMG activation. Likewise, only the responders demonstrated decreases in burst duration and cocontraction of proximal (hamstrings and quadriceps) muscle activity. Surprisingly, the proximal muscle activity in the responders, unlike nonresponders, was three- to fourfold greater than that in uninjured control subjects walking at similar speeds and level of body weight support, suggesting that the ability to modify muscle activation patterns after injury may predict the ability of subjects to further compensate in response to motor training. In summary, increases in the amount and decreases in the duration of EMG activity of specific muscles are associated with functional recovery of walking skills after treadmill training in subjects that are able to modify muscle activity patterns following incomplete spinal cord injury. PMID:19073799

GENERALIZATION OF TREADMILL-SLIP TRAINING TO PREVENT A FALL FOLLLOWING A SUDDEN (NOVEL) SLIP IN OVER-GROUND WALKING

PubMed Central

Yang, Feng; Bhatt, Tanvi; Pai, Yi-Chung

2012-01-01

The purposes of the study were to determine 1) whether treadmill-slip training could reduce the likelihood of falls during a novel slip in over-ground walking, and 2) to what extent such (indirect) training would be comparable to (direct) over-ground-slip training. A treadmill-slip training group (Group A, n=17) initially experienced repeated perturbations on treadmill intended to simulate forward-slip in over-ground walking. Perturbation continued and its intensity reduced when necessary to ensure subjects’ successful adaptation (i.e., when they could land their trailing foot ahead of the slipping foot in at least 3 of 5 consecutive trials). They then experienced a novel slip during over-ground walking. Another 17 young adults in Group B experienced an identical novel slip that served as the controls. They then underwent more slip trials during over-ground walking. Their 16th slip trial was analyzed to represent the over-ground-slip training effect. Eight subjects (47%) in Group A fell upon their first treadmill slip, while all adapted successfully after a minimum of 15 slip trials. Upon the novel slip during over-ground walking, none of them fell in comparison to four subjects (23.5%) fell in Group B upon the same trial (p<0.05). Group A’s control of stability, both proactive and reactive, was significantly better than that of Group B’s on their first over-ground slip, while the level of improvement derived from indirect treadmill training was not as strong as that from direct over-ground-slip training, as demonstrated in Group B’s 16th slip trial (p<0.001). These results clearly demonstrated the feasibility of fall reduction through treadmill-slip training. PMID:23141636

Functional Outcome of Neurologic-Controlled HAL-Exoskeletal Neurorehabilitation in Chronic Spinal Cord Injury: A Pilot With One Year Treatment and Variable Treatment Frequency.

PubMed

Jansen, Oliver; Schildhauer, Thomas A; Meindl, Renate C; Tegenthoff, Martin; Schwenkreis, Peter; Sczesny-Kaiser, Matthias; Grasmücke, Dennis; Fisahn, Christian; Aach, Mirko

2017-12-01

Longitudinal prospective study. Whether 1-year HAL-BWSTT of chronic spinal cord injured patients can improve independent ambulated mobility further as a function of training frequency, after an initial 3-month training period. Eight patients with chronic SCI were enrolled. They initially received full standard physical therapy and neurorehabilitation in the acute/subacute posttrauma phase. During this trial, all patients first underwent a daily (5 per week) HAL-BWSTT for 12 weeks. Subsequently, these patients performed a 40-week HAL-BWSTT with a training session frequency of either 1 or 3 to 5 sessions per week. The patients' functional status including HAL-associated treadmill-walking time, -distance, and -speed with additional analysis of gait pattern, and their independent (without wearing the robot suit) functional mobility improvements, were assessed using the 10-Meter-Walk Test (10MWT), Timed-Up-and-Go Test (TUG) and 6-Minute-Walk Test (6MinWT) on admission, at 6 weeks, 12 weeks, and 1 year after enrollment. The data were analyzed separately for the 2 training frequency subgroups after the initial 12-week training period, which was identical in both groups. During the 1-year follow-up, HAL-associated walking parameters and independent functional improvements were maintained in all the patients. This result held irrespective of the training frequency. Long-term 1-year maintenance of HAL-associated treadmill walking parameters and of improved independent walking abilities after initial 12 weeks of daily HAL-BWSTT is possible and depends mainly on the patients' ambulatory status accomplished after initial training period. Subsequent regular weekly training, but not higher frequency training, seems to be sufficient to preserve the improvements accomplished.

Functional Outcome of Neurologic-Controlled HAL-Exoskeletal Neurorehabilitation in Chronic Spinal Cord Injury: A Pilot With One Year Treatment and Variable Treatment Frequency

PubMed Central

Schildhauer, Thomas A.; Meindl, Renate C.; Tegenthoff, Martin; Schwenkreis, Peter; Sczesny-Kaiser, Matthias; Grasmücke, Dennis; Fisahn, Christian; Aach, Mirko

2017-01-01

Study Design: Longitudinal prospective study. Objectives: Whether 1-year HAL-BWSTT of chronic spinal cord injured patients can improve independent ambulated mobility further as a function of training frequency, after an initial 3-month training period. Methods: Eight patients with chronic SCI were enrolled. They initially received full standard physical therapy and neurorehabilitation in the acute/subacute posttrauma phase. During this trial, all patients first underwent a daily (5 per week) HAL-BWSTT for 12 weeks. Subsequently, these patients performed a 40-week HAL-BWSTT with a training session frequency of either 1 or 3 to 5 sessions per week. The patients’ functional status including HAL-associated treadmill-walking time, -distance, and -speed with additional analysis of gait pattern, and their independent (without wearing the robot suit) functional mobility improvements, were assessed using the 10-Meter-Walk Test (10MWT), Timed-Up-and-Go Test (TUG) and 6-Minute-Walk Test (6MinWT) on admission, at 6 weeks, 12 weeks, and 1 year after enrollment. The data were analyzed separately for the 2 training frequency subgroups after the initial 12-week training period, which was identical in both groups. Results: During the 1-year follow-up, HAL-associated walking parameters and independent functional improvements were maintained in all the patients. This result held irrespective of the training frequency. Conclusions: Long-term 1-year maintenance of HAL-associated treadmill walking parameters and of improved independent walking abilities after initial 12 weeks of daily HAL-BWSTT is possible and depends mainly on the patients’ ambulatory status accomplished after initial training period. Subsequent regular weekly training, but not higher frequency training, seems to be sufficient to preserve the improvements accomplished. PMID:29238636

Effects of treadmill training with the eyes closed on gait and balance ability of chronic stroke patients.

PubMed

Kim, Yong-Wook; Moon, Sung-Jun

2015-09-01

[Purpose] The purpose of this study was to compare the effect of treadmill walking with the eyes closed and open on the gait and balance abilities of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. Gait ability was measured using a Biodex Gait Trainer Treadmill System. Balance ability was measured using a Biodex Balance System. [Results] After the treadmill training' the treadmill training with eyes closed (TEC) group showed significant improvements in walking distance' step length' coefficient of variation' and limit of stability (overall' lateral affected' forward lateral unaffected) compared to the treadmill training with eyes open (TEO) group. [Conclusion] The walking and balance abilities of the TEC participants showed more improvement after the treadmill walking sessions than those of the TEO participants. Therefore' treadmill walking with visual deprivation may be useful for the rehabilitation of patients with chronic stroke.

How trained volunteers can improve the quality of hospital care for older patients. A qualitative evaluation within the Hospital Elder Life Program (HELP).

PubMed

Steunenberg, Bas; van der Mast, Roos; Strijbos, Marije J; Inouye, Sharon K; Schuurmans, Marieke J

The aim of this study was to investigate, using a mixed-methods design, the added value of a trained Hospital Elder Life Program (HELP) volunteer to the quality of hospital care in the Netherlands. The trained volunteers daily stimulate older patients, at risk of a delirium, to eat, to drink, and to exercise, and they provide walking assistance and cognitive stimulation. This study showed that each group appreciated the extra attention and service from the volunteers. The positive effect on feelings of loneliness during the hospital stay was an unexpected outcome. The volunteers themselves appreciated their work. In conclusion, a HELP volunteer should be provided to every older hospital patient. Copyright © 2016 Elsevier Inc. All rights reserved.

United States Army physical readiness training: rationale and evaluation of the physical training doctrine.

PubMed

Knapik, Joseph J; Rieger, William; Palkoska, Frank; Van Camp, Steven; Darakjy, Salima

2009-07-01

This paper reviews the rationale and evaluations of Physical Readiness Training (PRT), the new U.S. Army physical training doctrine designed to improve soldiers' physical capability for military operations. The purposes of PRT are to improve physical fitness, prevent injuries, progressively train soldiers, and develop soldiers' self-confidence and discipline. The PRT follows the principles of progressive overload, regularity, specificity, precision, variety, and balance. Specificity was achieved by examining the standard list of military (warrior) tasks and determining 1) the physical requirements, 2) the fitness components involved, and 3) the training activities that most likely could improve the military tasks. Injury-prevention features include reduced running mileage, exercise variety (cross-training), and gradual, progressive training. In 3 military field studies, the overall adjusted risk of injury was 1.5-1.8 times higher in groups of soldiers performing traditional military physical training programs when compared with groups using a PRT program. Scores on the Army Physical Fitness Test were similar or higher in groups using PRT programs. In an 8-week laboratory study comparing PRT with a weightlifting/running program, both programs resulted in major improvements in militarily relevant tasks (e.g., 3.2-km walk/run with 32-kg load, 400-m run with 18-kg load, 5- to 30-second rushes to and from prone position, 80-kg casualty drag, obstacle course). When compared with traditional military physical training programs, PRT consistently resulted in fewer injuries and in equal or greater improvements in fitness and military task performance.

Functional effects of treadmill-based gait training at faster speeds in stroke survivors: a prospective, single-group study.

PubMed

Mohammadi, Roghayeh; Ershad, Navid; Rezayinejad, Marziyeh; Fatemi, Elham; Phadke, Chetan P

2017-09-01

To examine the functional effects of walking retraining at faster than self-selected speed (SSS). Ten individuals with chronic stroke participated in a 4-week training over a treadmill at walking speeds 40% faster than SSS, three times per week, 30 min/session. Outcome measures assessed before, after, and 2 months after the end of intervention were the Timed Up and Go, the 6-Minute Walk, the 10-Meter Walk test, the Modified Ashworth Scale, SSS, and fastest comfortable speed. After 4 weeks of training, all outcome measures showed clinically meaningful and statistically significant improvements (P<0.05) that were maintained at 2 months after the end of the training. The results showed that a strategy of training at a speed 40% faster than SSS can improve functional activity in individuals with chronic stroke, with effects lasting up to 2 months after the intervention.

A randomized controlled trial to evaluate the feasibility of the Wii Fit for improving walking in older adults with lower limb amputation.

PubMed

Imam, Bita; Miller, William C; Finlayson, Heather; Eng, Janice J; Jarus, Tal

2017-01-01

To assess the feasibility of Wii.n.Walk for improving walking capacity in older adults with lower limb amputation. A parallel, evaluator-blind randomized controlled feasibility trial. Community-living. Individuals who were ⩾50 years old with a unilateral lower limb amputation. Wii.n.Walk consisted of Wii Fit training, 3x/week (40 minute sessions), for 4 weeks. Training started in the clinic in groups of 3 and graduated to unsupervised home training. Control group were trained using cognitive games. Feasibility indicators: trial process (recruitment, retention, participants' perceived benefit from the Wii.n.Walk intervention measured by exit questionnaire), resources (adherence), management (participant processing, blinding), and treatment (adverse event, and Cohen's d effect size and variance). Primary clinical outcome: walking capacity measured using the 2 Minute Walk Test at baseline, end of treatment, and 3-week retention. Of 28 randomized participants, 24 completed the trial (12/arm). Median (range) age was 62.0 (50-78) years. Mean (SD) score for perceived benefit from the Wii.n.Walk intervention was 38.9/45 (6.8). Adherence was 83.4%. The effect sizes for the 2 Minute Walk Test were 0.5 (end of treatment) and 0.6 (3-week retention) based on intention to treat with imputed data; and 0.9 (end of treatment) and 1.2 (3-week retention) based on per protocol analysis. The required sample size for a future larger RCT was deemed to be 72 (36 per arm). The results suggested the feasibility of the Wii.n.Walk with a medium effect size for improving walking capacity. Future larger randomized controlled trials investigating efficacy are warranted.

The effects of error augmentation on learning to walk on a narrow balance beam.

PubMed

Domingo, Antoinette; Ferris, Daniel P

2010-10-01

Error augmentation during training has been proposed as a means to facilitate motor learning due to the human nervous system's reliance on performance errors to shape motor commands. We studied the effects of error augmentation on short-term learning of walking on a balance beam to determine whether it had beneficial effects on motor performance. Four groups of able-bodied subjects walked on a treadmill-mounted balance beam (2.5-cm wide) before and after 30 min of training. During training, two groups walked on the beam with a destabilization device that augmented error (Medium and High Destabilization groups). A third group walked on a narrower beam (1.27-cm) to augment error (Narrow). The fourth group practiced walking on the 2.5-cm balance beam (Wide). Subjects in the Wide group had significantly greater improvements after training than the error augmentation groups. The High Destabilization group had significantly less performance gains than the Narrow group in spite of similar failures per minute during training. In a follow-up experiment, a fifth group of subjects (Assisted) practiced with a device that greatly reduced catastrophic errors (i.e., stepping off the beam) but maintained similar pelvic movement variability. Performance gains were significantly greater in the Wide group than the Assisted group, indicating that catastrophic errors were important for short-term learning. We conclude that increasing errors during practice via destabilization and a narrower balance beam did not improve short-term learning of beam walking. In addition, the presence of qualitatively catastrophic errors seems to improve short-term learning of walking balance.

Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3-yr longitudinal study.

PubMed

Sañudo, Borja; Carrasco, Luis; de Hoyo, Moisés; McVeigh, Joseph G

2012-07-01

This study aimed to evaluate the immediate effects of a 6-mo combined exercise program on quality-of-life, physical function, depression, and aerobic capacity in women with fibromyalgia syndrome and to determine the impact of repeated delivery of the intervention. Forty-one women with fibromyalgia were randomly assigned to a training group (EG; n = 21) and a control group (CG; n = 20). Quality-of-life and physical function were assessed using the 36-item Short-Form Health Survey (SF-36) and the Fibromyalgia Impact Questionnaire, and depression was measured using the Beck Depression Inventory. Physical fitness was measured using the 6-min Walk Test. Outcomes were assessed at baseline and after each 6-mo intervention, which was delivered over 30 mos (6 mos of training and 6 mos of detraining). After a 6-mo combined exercise program, there was a significant improvement in the Fibromyalgia Impact Questionnaire (P < 0.0005) for the training group over the control group. Repeated-measures analysis of variance across all time points demonstrated significant main effects for time for the Fibromyalgia Impact Questionnaire, SF-36, Beck Depression Inventory and the 6-min Walk Test, but there were no between-group interaction effects. For the EG, there were significant within-group changes in the Fibromyalgia Impact Questionnaire, SF-36, and Beck Depression Inventory at the final time point; however, there were no within-group changes for the control group. Improvement achieved for the training group were maintained during the detraining period. A long-term exercise program can produce immediate improvements in key health domains in women with fibromyalgia. The benefits achieved with regular training can be maintained for 30 mos. The lack of difference between groups over time may be caused by attrition and consequent lack of power at the final time point.

Nordic Walking for the Management of People With Parkinson Disease: A Systematic Review.

PubMed

Cugusi, Lucia; Manca, Andrea; Dragone, Daniele; Deriu, Franca; Solla, Paolo; Secci, Claudio; Monticone, Marco; Mercuro, Giuseppe

2017-11-01

It is well known that physical exercise is the main therapeutic element of rehabilitation programs for people with Parkinson disease (PD). As traditional forms of exercise can guarantee significant health benefits, the emergence of nonconventional physical activities, such as Nordic walking (NW), may add positive effects. To appraise the available evidence on the main effects of NW in the rehabilitation programs for people with PD and to propose a design for upcoming research that might improve the uniformity of future trials. Systematic review. A literature search of 5 established databases (PubMed, MEDLINE, Scopus, Web of Science, and Cochrane) was conducted. Any relevant randomized controlled trials pertinent to NW in PD published in English from inception to February 2017 were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the methodologic quality of each study was assessed by the Physiotherapy Evidence Database scale. Sixty-six studies were retrieved, and 6 randomized controlled trials (221 subjects) were entered into the qualitative synthesis. Overall, these studies portrayed NW as feasible and likely to be effective in improving the functional and clinical outcomes of people with PD. When we compared NW with other exercise-based interventions, such as treadmill training, free walking, a program of standardized whole-body movements with maximal amplitude (Lee Silverman Voice Treatment BIG training), or a home-based exercise program, the findings proved controversial. High heterogeneity and methodologic discrepancies among the studies prevent us from drawing firm conclusions on the effectiveness of NW in comparison with other exercise-based interventions currently used by people with PD. Further investigations with a common design are necessary to verify whether NW may be included within conventional rehabilitation programs commonly recommended to people with PD. II. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

A Survey of Immersive Technology For Maintenance Evaluations

DTIC Science & Technology

1998-04-01

image display system. Based on original work performed at the German National Computer Science and Mathematics Research Institute (GMD), and further...simulations, architectural walk- throughs, medical simulations, general research , entertainment applications and location based entertainment use...simulations. This study was conducted as part of a logistics research and development program Design Evaluation for Personnel, Training, and Human Factors

Effects of modified Pilates on variability of inter-joint coordination during walking in the elderly

PubMed Central

Roh, SuYeon; Yoon, Sukhoon; Kim, Joo Nyeon; Lim, Hee Sung

2016-01-01

[Purpose] This study aimed to examine the effects of an 8-week modified Pilates program on the variability of inter-joint coordination in the elderly during walking. [Subjects and Methods] Twenty elderly participants with no recent history of orthopedic abnormalities (age, 67.9 ± 2.7 years; height, 163.7 ± 8.9 cm; weight, 67.1 ± 11.6 kg) were recruited for this study and randomly allocated to a modified Pilates exercise group or a control group. Three-dimensional motion analysis was performed on both groups to evaluate the effects of the Pilates exercise. [Results] There was no significant difference in the joint variability of the ankle, knee, and hip joints between the groups, both before training and after training. However, there was a significant increase in the hip-knee deviation phase value in the exercise group after the program was completed, and this increase was also significant when compared with that in the control group. [Conclusion] This study has demonstrated that an 8-week modified Pilates exercise program can have a positive impact on the gait of elderly participants, potentially by enhancing neuromuscular adjustment, which may have positive implications for reducing their fall risk. PMID:28174474

Does Combined Physical and Cognitive Training Improve Dual-Task Balance and Gait Outcomes in Sedentary Older Adults?

PubMed Central

Fraser, Sarah A.; Li, Karen Z.-H.; Berryman, Nicolas; Desjardins-Crépeau, Laurence; Lussier, Maxime; Vadaga, Kiran; Lehr, Lora; Minh Vu, Thien Tuong; Bosquet, Laurent; Bherer, Louis

2017-01-01

Everyday activities like walking and talking can put an older adult at risk for a fall if they have difficulty dividing their attention between motor and cognitive tasks. Training studies have demonstrated that both cognitive and physical training regimens can improve motor and cognitive task performance. Few studies have examined the benefits of combined training (cognitive and physical) and whether or not this type of combined training would transfer to walking or balancing dual-tasks. This study examines the dual-task benefits of combined training in a sample of sedentary older adults. Seventy-two older adults (≥60 years) were randomly assigned to one of four training groups: Aerobic + Cognitive training (CT), Aerobic + Computer lessons (CL), Stretch + CT and Stretch + CL. It was expected that the Aerobic + CT group would demonstrate the largest benefits and that the active placebo control (Stretch + CL) would show the least benefits after training. Walking and standing balance were paired with an auditory n-back with two levels of difficulty (0- and 1-back). Dual-task walking and balance were assessed with: walk speed (m/s), cognitive accuracy (% correct) and several mediolateral sway measures for pre- to post-test improvements. All groups demonstrated improvements in walk speed from pre- (M = 1.33 m/s) to post-test (M = 1.42 m/s, p < 0.001) and in accuracy from pre- (M = 97.57%) to post-test (M = 98.57%, p = 0.005).They also increased their walk speed in the more difficult 1-back (M = 1.38 m/s) in comparison to the 0-back (M = 1.36 m/s, p < 0.001) but reduced their accuracy in the 1-back (M = 96.39%) in comparison to the 0-back (M = 99.92%, p < 0.001). Three out of the five mediolateral sway variables (Peak, SD, RMS) demonstrated significant reductions in sway from pre to post test (p-values < 0.05). With the exception of a group difference between Aerobic + CT and Stretch + CT in accuracy, there were no significant group differences after training. Results suggest that there can be dual-task benefits from training but that in this sedentary sample Aerobic + CT training was not more beneficial than other types of combined training. PMID:28149274

Effects of physical guidance on short-term learning of walking on a narrow beam.

PubMed

Domingo, Antoinette; Ferris, Daniel P

2009-11-01

Physical guidance is often used in rehabilitation when teaching patients to re-learn movements. However, the effects of guidance on motor learning of complex skills, such as walking balance, are not clear. We tested four groups of healthy subjects that practiced walking on a narrow (1.27 cm) or wide (2.5 cm) treadmill-mounted balance beam, with or without physical guidance. Assistance was given by springs attached to a hip belt that applied restoring forces towards beam center. Subjects were evaluated while walking unassisted before and after training by calculating the number of times subjects stepped off of the beam per minute of successful walking on the beam (Failures per Minute). Subjects in Unassisted groups had greater performance improvements in walking balance from pre to post compared to subjects in Assisted groups. During training, Unassisted groups had more Failures per Minute than Assisted groups. Performance improvements were smaller in Narrow Beam groups than in Wide Beam groups. The Unassisted-Wide and Assisted-Narrow groups had similar Failures per Minute during training, but the Unassisted-Wide group had much greater performance gains after training. These results suggest that physical assistance can hinder motor learning of walking balance, assistance appears less detrimental for more difficult tasks, and task-specific dynamics are important to learning independent of error experience.

Curved Walking Rehabilitation with a Rotating Treadmill in Patients with Parkinson’s Disease: A Proof of Concept

PubMed Central

Godi, Marco; Giardini, Marica; Nardone, Antonio; Turcato, Anna Maria; Caligari, Marco; Pisano, Fabrizio; Schieppati, Marco

2017-01-01

Training subjects to step-in-place eyes open on a rotating platform while maintaining a fixed body orientation in space [podokinetic stimulation (PKS)] produces a posteffect consisting in inadvertent turning around while stepping-in-place eyes closed [podokinetic after-rotation (PKAR)]. Since the rationale for rehabilitation of curved walking in Parkinson’s disease is not fully known, we tested the hypothesis that repeated PKS favors the production of curved walking in these patients, who are uneasy with turning, even when straight walking is little affected. Fifteen patients participated in 10 training sessions distributed in 3 weeks. Both counterclockwise and clockwise PKS were randomly administered in each session. PKS velocity and duration were gradually increased over sessions. The velocity and duration of the following PKAR were assessed. All patients showed PKAR, which increased progressively in peak velocity and duration. In addition, before and at the end of the treatment, all patients walked overground along linear and circular trajectories. Post-training, the velocity of walking bouts increased, more so for the circular than the linear trajectory. Cadence was not affected. This study has shown that parkinsonian patients learn to produce turning while stepping when faced with appropriate training and that this capacity translates into improved overground curved walking. PMID:28293213

Curved Walking Rehabilitation with a Rotating Treadmill in Patients with Parkinson's Disease: A Proof of Concept.

PubMed

Godi, Marco; Giardini, Marica; Nardone, Antonio; Turcato, Anna Maria; Caligari, Marco; Pisano, Fabrizio; Schieppati, Marco

2017-01-01

Training subjects to step-in-place eyes open on a rotating platform while maintaining a fixed body orientation in space [podokinetic stimulation (PKS)] produces a posteffect consisting in inadvertent turning around while stepping-in-place eyes closed [podokinetic after-rotation (PKAR)]. Since the rationale for rehabilitation of curved walking in Parkinson's disease is not fully known, we tested the hypothesis that repeated PKS favors the production of curved walking in these patients, who are uneasy with turning, even when straight walking is little affected. Fifteen patients participated in 10 training sessions distributed in 3 weeks. Both counterclockwise and clockwise PKS were randomly administered in each session. PKS velocity and duration were gradually increased over sessions. The velocity and duration of the following PKAR were assessed. All patients showed PKAR, which increased progressively in peak velocity and duration. In addition, before and at the end of the treatment, all patients walked overground along linear and circular trajectories. Post-training, the velocity of walking bouts increased, more so for the circular than the linear trajectory. Cadence was not affected. This study has shown that parkinsonian patients learn to produce turning while stepping when faced with appropriate training and that this capacity translates into improved overground curved walking.

A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial

PubMed Central

Imam, Bita; Finlayson, Heather C; Eng, Janice J; Payne, Michael WC; Jarus, Tal; Goldsmith, Charles H; Mitchell, Ian M

2014-01-01

Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Results Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Conclusions Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial Registration Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP). PMID:25533902

Unexpected recovery after robotic locomotor training at physiologic stepping speed: a single-case design.

PubMed

Spiess, Martina R; Jaramillo, Jeffrey P; Behrman, Andrea L; Teraoka, Jeffrey K; Patten, Carolynn

2012-08-01

To investigate the effect of walking speed on the emergence of locomotor electromyogram (EMG) patterns in an individual with chronic incomplete spinal cord injury (SCI), and to determine whether central pattern generator activity during robotic locomotor training (RLT) transfers to volitional EMG activity during overground walking. Single-case (B-A-B; experimental treatment-withdrawal-experimental treatment) design. Freestanding rehabilitation research center. A 50-year-old man who was nonambulatory for 16 months after incomplete SCI (sub-T11). The participant completed two 6-week blocks of RLT, training 4 times per week for 30 minutes per session at walking speeds up to 5km/h (1.4m/s) over continuous bouts lasting up to 17 minutes. Surface EMG was recorded weekly during RLT and overground walking. The Walking Index for Spinal Cord Injury (WISCI-II) was assessed daily during training blocks. During week 4, reciprocal, patterned EMG emerged during RLT. EMG amplitude modulation revealed a curvilinear relationship over the range of walking speeds from 1.5 to 5km/h (1.4m/s). Functionally, the participant improved from being nonambulatory (WISCI-II 1/20), to walking overground with reciprocal stepping using knee-ankle-foot orthoses and a walker (WISCI-II 9/20). EMG was also observed during overground walking. These functional gains were maintained greater than 4 years after locomotor training (LT). Here we report an unexpected course of locomotor recovery in an individual with chronic incomplete SCI. Through RLT at physiologic walking speeds, it was possible to activate the central pattern generator even 16 months postinjury. Further, to a certain degree, improvements from RLT transferred to overground walking. Our results suggest that LT-induced changes affect the central pattern generator and allow supraspinal inputs to engage residual spinal pathways. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of the bilateral isokinetic strengthening training on functional parameters, gait, and the quality of life in patients with stroke.

PubMed

Büyükvural Şen, Sıdıka; Özbudak Demir, Sibel; Ekiz, Timur; Özgirgin, Neşe

2015-01-01

To evaluate the effects of the bilateral isokinetic strengthening training applied to knee and ankle muscles on balance, functional parameters, gait, and the quality of in stroke patients. Fifty patients (33 M, 17 F) with subacute-chronic stroke and 30 healthy subjects were included. Stroke patients were allocated into isokinetic and control groups. Conventional rehabilitation program was applied to all cases; additionally maximal concentric isokinetic strengthening training was applied to the knee-ankle muscles bilaterally to the isokinetic group 5 days a week for 3 weeks. Biodex System 3 Pro Multijoint System isokinetic dynamometer was used for isokinetic evaluation. The groups were assessed by Functional Independence Measure, Stroke Specific Quality of Life Scale, Timed 10-Meter Walk Test, Six-Minute Walk Test, Stair-Climbing Test, Timed up&go Test, Berg Balance Scale, and Rivermead Mobility Index. Compared with baseline, the isokinetic PT values of the knee and ankle on both sides significantly increased in all cases. PT change values were significantly higher in the isokinetic group than the control group (P<0.025). Furthermore, the quality of life, gait, balance and mobility index values improved significantly in both groups, besides the increase levels were found significantly higher in the isokinetic group (P<0.025, P<0.05). Bilateral isokinetic strengthening training in addition to conventional rehabilitation program after stroke seems to be effective on strengthening muscles on both sides, improving functional parameters, gait, balance and life quality.

Effects of the bilateral isokinetic strengthening training on functional parameters, gait, and the quality of life in patients with stroke

PubMed Central

Büyükvural Şen, Sıdıka; Özbudak Demir, Sibel; Ekiz, Timur; Özgirgin, Neşe

2015-01-01

Objective: To evaluate the effects of the bilateral isokinetic strengthening training applied to knee and ankle muscles on balance, functional parameters, gait, and the quality of in stroke patients. Methods: Fifty patients (33 M, 17 F) with subacute-chronic stroke and 30 healthy subjects were included. Stroke patients were allocated into isokinetic and control groups. Conventional rehabilitation program was applied to all cases; additionally maximal concentric isokinetic strengthening training was applied to the knee-ankle muscles bilaterally to the isokinetic group 5 days a week for 3 weeks. Biodex System 3 Pro Multijoint System isokinetic dynamometer was used for isokinetic evaluation. The groups were assessed by Functional Independence Measure, Stroke Specific Quality of Life Scale, Timed 10-Meter Walk Test, Six-Minute Walk Test, Stair-Climbing Test, Timed up&go Test, Berg Balance Scale, and Rivermead Mobility Index. Results: Compared with baseline, the isokinetic PT values of the knee and ankle on both sides significantly increased in all cases. PT change values were significantly higher in the isokinetic group than the control group (P<0.025). Furthermore, the quality of life, gait, balance and mobility index values improved significantly in both groups, besides the increase levels were found significantly higher in the isokinetic group (P<0.025, P<0.05). Conclusion: Bilateral isokinetic strengthening training in addition to conventional rehabilitation program after stroke seems to be effective on strengthening muscles on both sides, improving functional parameters, gait, balance and life quality. PMID:26629238

Kinematic and muscle demand similarities between motor-assisted elliptical training and walking: Implications for pediatric gait rehabilitation.

PubMed

Burnfield, Judith M; Cesar, Guilherme M; Buster, Thad W; Irons, Sonya L; Nelson, Carl A

2017-01-01

Many children with physical disabilities and special health care needs experience barriers to accessing effective therapeutic technologies to improve walking and fitness in healthcare and community environments. The expense of many robotic and exoskeleton technologies hinders widespread use in most clinics, school settings, and fitness facilities. A motor-assisted elliptical trainer that is being used to address walking and fitness deficits in adults was modified to enable children as young as three years of age to access the technology (Pedi-ICARE). We compared children's kinematic and muscle activation patterns during walking and training on the Pedi-ICARE. Eighteen children walked (self-selected comfortable speed), Pedi-ICARE trained with motor-assistance at self-selected comfortable speed (AAC), and trained while over-riding motor-assistance (AAC+). Coefficient of multiple correlations (CMCs) compared lower extremity kinematic profiles during AAC and AAC+ to gait. Repeated measures ANOVAs identified muscle demand differences across conditions. CMCs revealed strong similarities at the hip and knee between each motor-assisted elliptical condition and gait. Ankle CMCs were only moderate. Muscle demands were generally lowest during AAC. Over-riding the motor increased hip and knee muscle demands. The similarity of motion patterns between Pedi-ICARE conditions and walking suggest the device could be used to promote task-specific training to improve walking. The capacity to manipulate muscle demands using different motor-assistance conditions highlights Pedi-ICARE's versatility in addressing a wide range of children's abilities. Copyright © 2016 Elsevier B.V. All rights reserved.

The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report.

PubMed

Foster, Hannah; DeMark, Lou; Spigel, Pamela M; Rose, Dorian K; Fox, Emily J

2016-10-01

Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance, and upright mobility in an individual with chronic ISCI. A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT), 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted.

The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report

PubMed Central

Foster, Hannah; DeMark, Lou; Spigel, Pamela M.; Rose, Dorian K.; Fox, Emily J.

2016-01-01

Background/Purpose Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance and upright mobility in an individual with chronic ISCI. Methods A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT); 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. Results Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. Conclusions The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted. PMID:27482619

Effects of combined aerobic and resistance exercise on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis.

PubMed

Lee, Yong Hee; Park, Soo Hyun; Yoon, Eun Sun; Lee, Chong-Do; Wee, Sang Ouk; Fernhall, Bo; Jae, Sae Young

2015-09-01

The effects of combined aerobic and resistance exercise training on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis were investigated. Twenty-six patients with chronic poststroke hemiparesis were randomly assigned to either the combined aerobic and resistance exercise group (n = 14) or the control group (n = 12). The exercise intervention group received a combined aerobic and resistance exercise training (1 hr/day, three times/week for 16 wks), whereas the control group received usual care. Central arterial stiffness was determined by pulse wave velocity and augmentation index. Gait velocity was assessed using the 6-min walk test, 10-m walk test, and the Timed Up-and-Go test. Patients in the exercise intervention group had greater improvement of mean pulse wave velocity (P < 0.001), augmentation index (P = 0.048), and gait velocity (6-min walk test, P < 0.001; 10-m walk test, P < 0.001) than did patients in the control group. Patients in the exercise intervention group also had greater improvements in physical fitness component (grip strength, P < 0.001; muscular strength of upper and lower limbs, P < 0.027; flexibility, P < 0.001) when compared with control patients. The combined aerobic and resistance exercise program significantly reduced central arterial stiffness and increased gait velocity in patients with chronic poststroke hemiparesis.

Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial.

PubMed

Niemelä, Kristiina; Väänänen, Ilkka; Leinonen, Raija; Laukkanen, Pia

2011-08-01

Home-based exercise is a viable alternative for older adults with difficulties in exercise opportunities outside the home. The aim of this study was to investigate the benefits of home-based rocking-chair training, and its effects on the physical performance of elderly women. Community- dwelling women (n=51) aged 73-87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a six-week rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire. After the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects. Results indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.

Electromechanical-assisted training for walking after stroke.

PubMed

Mehrholz, Jan; Elsner, Bernhard; Werner, Cordula; Kugler, Joachim; Pohl, Marcus

2013-07-25

Electromechanical and robotic-assisted gait training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007. To investigate the effects of automated electromechanical and robotic-assisted gait training devices for improving walking after stroke. We searched the Cochrane Stroke Group Trials Register (last searched April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2), MEDLINE (1966 to November 2012), EMBASE (1980 to November 2012), CINAHL (1982 to November 2012), AMED (1985 to November 2012), SPORTDiscus (1949 to September 2012), the Physiotherapy Evidence Database (PEDro, searched November 2012) and the engineering databases COMPENDEX (1972 to November 2012) and INSPEC (1969 to November 2012). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists and contacted authors in an effort to identify further published, unpublished and ongoing trials. We included all randomised and randomised cross-over trials consisting of people over 18 years old diagnosed with stroke of any severity, at any stage, or in any setting, evaluating electromechanical and robotic-assisted gait training versus normal care. Two review authors independently selected trials for inclusion, assessed methodological quality and extracted the data. The primary outcome was the proportion of participants walking independently at follow-up. In this update of our review, we included 23 trials involving 999 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (OR) (random effects) 2.39, 95% confidence interval (CI) 1.67 to 3.43; P < 0.00001; I² = 0%) but did not significantly increase walking velocity (mean difference (MD) = 0.04 metres/s, 95% CI -0.03 to 0.11; P = 0.26; I² = 73%) or walking capacity (MD = 3 metres walked in six minutes, 95% CI -29 to 35; P = 0.86; I² = 70%). The results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variations between the trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Our planned subgroup analysis suggests that people in the acute phase may benefit but people in the chronic phase may not benefit from electromechanical-assisted gait training. Post hoc analysis showed that people who are non-ambulatory at intervention onset may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk, but significant differences were found between devices in terms of walking velocity. People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of a large definitive, pragmatic, phase III trial undertaken to address specific questions such as the following: What frequency or duration of electromechanical-assisted gait training might be most effective? How long does the benefit last?

An overview of the "Positive Action for Today's Health" (PATH) trial for increasing walking in low income, ethnic minority communities.

PubMed

Wilson, Dawn K; Trumpeter, Nevelyn N; St George, Sara M; Coulon, Sandra M; Griffin, Sarah; Lee Van Horn, M; Lawman, Hannah G; Wandersman, Abe; Egan, Brent; Forthofer, Melinda; Goodlett, Benjamin D; Kitzman-Ulrich, Heather; Gadson, Barney

2010-11-01

Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities. Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months. The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months. Implications of this community-based trial are discussed. Copyright © 2010. Published by Elsevier Inc.

An overview of the “Positive Action for Today's Health” (PATH) trial for increasing walking in low income, ethnic minority communities

PubMed Central

Wilson, Dawn K.; Trumpeter, Nevelyn N.; St. George, Sara M.; Coulon, Sandra M.; Griffin, Sarah; Van Horn, M. Lee; Lawman, Hannah G.; Wandersman, Abe; Egan, Brent; Forthofer, Melinda; Goodlett, Benjamin D.; Kitzman-Ulrich, Heather; Gadson, Barney

2012-01-01

Background Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities. Design and setting Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months. Intervention The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. Main hypotheses/outcomes It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months. Conclusions Implications of this community-based trial are discussed. PMID:20801233

Generalization of treadmill perturbation to overground slip during gait: Effect of different perturbation distances on slip recovery.

PubMed

Lee, Anna; Bhatt, Tanvi; Pai, Yi-Chung

2016-01-25

Treadmill-perturbation training (TM-training) may improve a person׳s fall-resistance, whereby adjusting slip distance can be a simple way to manipulate training intensity. The purpose of this study was to determine the effects of different slip distances in TM-training (12-cm vs. 18-cm) on its generalization to the recovery from a novel "free" slip during overground walking. Generalization here means the ability to apply learned skill from TM-training to slip recovery during overground walking. Thirty-six young adults in the TM_12 or the TM_18 group underwent either a 12-cm or an 18-cm slip during the treadmill walking for seven times, or in the control group were not exposed to any perturbation. Their responses were also contrasted with previously reported results from overground-perturbation training (OG-training) in which participants received either a 12-cm or an 18-cm slip during level walking with the same number of repetitions. Everyone was then exposed to the same generalization test during a novel "free" slip in overground walking. Their proactive and reactive control of stability was measured and compared. TM-training displayed a significant training effect in comparison to the control group (p<0.05), while most of the improvements were found in the reactive control of stability and were much-limited in comparison to that of OG-training. Also unlike OG-training, no significant differences were found between the results obtained from the TM_12 and the TM_18 groups (p>0.05). These results underscore the further needs to investigate the potential of the treadmill as a convenient instrument that can effectively deliver perturbation training. Published by Elsevier Ltd.

Generalization of treadmill perturbation to overground slip during gait: Effect of different perturbation distances on slip recovery

PubMed Central

Lee, Anna; Bhatt, Tanvi; Pai, Yi-Chung

2016-01-01

Treadmill-perturbation training (TM-training) may improve a person’s fall-resistance, whereby adjusting slip distance can be a simple way to manipulate training intensity. The purpose of this study was to determine the effects of different slip distances in TM-training (12-cm vs. 18-cm) on its generalization to the recovery from a novel “free” slip during overground walking. Generalization here means the ability to apply learned skill from TM-training to slip recovery during overground walking. Thirty-six young adults in the TM_12 or the TM_18 group underwent either a 12-cm or an 18-cm slip during the treadmill walking for seven times, or in the control group were not exposed to any perturbation. Their responses were also contrasted with previously reported results from overground-perturbation training (OG-training) in which participants received either a 12-cm or an 18-cm slip during level walking with the same number of repetitions. Everyone was then exposed to the same generalization test during a novel “free” slip in overground walking. Their proactive and reactive control of stability was measured and compared. TM-training displayed a significant training effect in comparison to the control group (p<0.05), while most of the improvements were found in the reactive control of stability and were much-limited in comparison to that of OG-training. Also unlike OG-training, no significant differences were found between the results obtained from the TM_12 and the TM_18 groups (p>0.05). These results underscore the further needs to investigate the potential of the treadmill as a convenient instrument that can effectively deliver perturbation training. PMID:26653674

Physiological responses and energy cost of walking on the Gait Trainer with and without body weight support in subacute stroke patients

PubMed Central

2014-01-01

Background Robotic-assisted walking after stroke provides intensive task-oriented training. But, despite the growing diffusion of robotic devices little information is available about cardiorespiratory and metabolic responses during electromechanically-assisted repetitive walking exercise. Aim of the study was to determine whether use of an end-effector gait training (GT) machine with body weight support (BWS) would affect physiological responses and energy cost of walking (ECW) in subacute post-stroke hemiplegic patients. Methods Participants: six patients (patient group: PG) with hemiplegia due to stroke (age: 66 ± 15y; time since stroke: 8 ± 3 weeks; four men) and 6 healthy subjects as control group (CG: age, 76 ± 7y; six men). Interventions: overground walking test (OWT) and GT-assisted walking with 0%, 30% and 50% BWS (GT-BWS0%, 30% and 50%). Main Outcome Measures: heart rate (HR), pulmonary ventilation, oxygen consumption, respiratory exchange ratio (RER) and ECW. Results Intervention conditions significantly affected parameter values in steady state (HR: p = 0.005, V’E: p = 0.001, V'O2: p < 0.001) and the interaction condition per group affected ECW (p = 0.002). For PG, the most energy (V’O2 and ECW) demanding conditions were OWT and GT-BWS0%. On the contrary, for CG the least demanding condition was OWT. On the GT, increasing BWS produced a decrease in energy and cardiac demand in both groups. Conclusions In PG, GT-BWS walking resulted in less cardiometabolic demand than overground walking. This suggests that GT-BWS walking training might be safer than overground walking training in subacute stroke patients. PMID:24720844

Physiological responses and energy cost of walking on the Gait Trainer with and without body weight support in subacute stroke patients.

PubMed

Delussu, Anna Sofia; Morone, Giovanni; Iosa, Marco; Bragoni, Maura; Traballesi, Marco; Paolucci, Stefano

2014-04-10

Robotic-assisted walking after stroke provides intensive task-oriented training. But, despite the growing diffusion of robotic devices little information is available about cardiorespiratory and metabolic responses during electromechanically-assisted repetitive walking exercise. Aim of the study was to determine whether use of an end-effector gait training (GT) machine with body weight support (BWS) would affect physiological responses and energy cost of walking (ECW) in subacute post-stroke hemiplegic patients. six patients (patient group: PG) with hemiplegia due to stroke (age: 66 ± 15y; time since stroke: 8 ± 3 weeks; four men) and 6 healthy subjects as control group (CG: age, 76 ± 7y; six men). overground walking test (OWT) and GT-assisted walking with 0%, 30% and 50% BWS (GT-BWS0%, 30% and 50%). heart rate (HR), pulmonary ventilation, oxygen consumption, respiratory exchange ratio (RER) and ECW. Intervention conditions significantly affected parameter values in steady state (HR: p = 0.005, V'E: p = 0.001, V'O2: p < 0.001) and the interaction condition per group affected ECW (p = 0.002). For PG, the most energy (V'O2 and ECW) demanding conditions were OWT and GT-BWS0%. On the contrary, for CG the least demanding condition was OWT. On the GT, increasing BWS produced a decrease in energy and cardiac demand in both groups. In PG, GT-BWS walking resulted in less cardiometabolic demand than overground walking. This suggests that GT-BWS walking training might be safer than overground walking training in subacute stroke patients.

Influence of Systematic Increases in Treadmill Walking Speed on Gait Kinematics After Stroke

PubMed Central

Tyrell, Christine M.; Roos, Margaret A.; Rudolph, Katherine S.

2011-01-01

Background Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill. Objective The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke. Design A repeated-measures design was used. Methods Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured. Results Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed. Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking. Conclusions Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed. PMID:21252308

Effects of a Flexibility and Relaxation Programme, Walking, and Nordic Walking on Parkinson's Disease

PubMed Central

Reuter, I.; Mehnert, S.; Leone, P.; Kaps, M.; Oechsner, M.; Engelhardt, M.

2011-01-01

Symptoms of Parkinson's disease (PD) progress despite optimized medical treatment. The present study investigated the effects of a flexibility and relaxation programme, walking, and Nordic walking (NW) on walking speed, stride length, stride length variability, Parkinson-specific disability (UPDRS), and health-related quality of life (PDQ 39). 90 PD patients were randomly allocated to the 3 treatment groups. Patients participated in a 6-month study with 3 exercise sessions per week, each lasting 70 min. Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved. Furthermore, walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS in addition. Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability. No significant injuries occurred during the training. All patients of the Nordic walking group continued Nordic walking after completing the study. PMID:21603199

Exergame and Balance Training Modulate Prefrontal Brain Activity during Walking and Enhance Executive Function in Older Adults

PubMed Central

Eggenberger, Patrick; Wolf, Martin; Schumann, Martina; de Bruin, Eling D.

2016-01-01

Different types of exercise training have the potential to induce structural and functional brain plasticity in the elderly. Thereby, functional brain adaptations were observed during cognitive tasks in functional magnetic resonance imaging studies that correlated with improved cognitive performance. This study aimed to investigate if exercise training induces functional brain plasticity during challenging treadmill walking and elicits associated changes in cognitive executive functions. Forty-two elderly participants were recruited and randomly assigned to either interactive cognitive-motor video game dancing (DANCE) or balance and stretching training (BALANCE). The 8-week intervention included three sessions of 30 min per week and was completed by 33 participants (mean age 74.9 ± 6.9 years). Prefrontal cortex (PFC) activity during preferred and fast walking speed on a treadmill was assessed applying functional near infrared spectroscopy pre- and post-intervention. Additionally, executive functions comprising shifting, inhibition, and working memory were assessed. The results showed that both interventions significantly reduced left and right hemispheric PFC oxygenation during the acceleration of walking (p < 0.05 or trend, r = 0.25–0.36), while DANCE showed a larger reduction at the end of the 30-s walking task compared to BALANCE in the left PFC [F(1, 31) = 3.54, p = 0.035, r = 0.32]. These exercise training induced modulations in PFC oxygenation correlated with improved executive functions (p < 0.05 or trend, r = 0.31–0.50). The observed reductions in PFC activity may release cognitive resources to focus attention on other processes while walking, which could be relevant to improve mobility and falls prevention in the elderly. This study provides a deeper understanding of the associations between exercise training, brain function during walking, and cognition in older adults. PMID:27148041

Effects of home-based locomotor treadmill training on gross motor function in young children with cerebral palsy: a quasi-randomized controlled trial.

PubMed

Mattern-Baxter, Katrin; McNeil, Stefani; Mansoor, Jim K

2013-11-01

To examine the effects of an intensive home-based program of treadmill training on motor skills related to walking in preambulatory children with cerebral palsy (CP). Quasi-randomized controlled trial. Homes of the participants. Children with CP (N=12) with Gross Motor Function Classification System levels I and II were assigned to the intervention group (n=6; mean age ± SD, 21.76±6.50mo) and control group (n=6; 21.25±6.07mo). All children were tested preintervention, postintervention, at a 1-month follow-up, and at a 4-month follow-up. All children received their weekly scheduled physical therapy sessions at their homes. In addition, children in the intervention group walked on a portable treadmill in their homes 6 times per week, twice daily for 10- to 20-minute sessions, for 6 weeks. The intervention was carried out by the children's parents with weekly supervision by a physical therapist. Gross Motor Function Measure-66 Dimensions D/E, Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Inventory (PEDI), timed 10-m walk test (10MWT), and Functional Mobility Scale (FMS). The Friedman test and Mann-Whitney U test were conducted for within-group and between-group differences, respectively. There was a significant between-group treatment effect for the PDMS-2 at posttest (P=.01) and 1-month postintervention follow-up (P=.09), as well as for the PEDI at posttest (P=.01), the 1-month postintervention follow-up (P=.009), and the 4-month postintervention follow-up (P=.04). The FMS was significant at the posttest (P=.04). Home-based treadmill training accelerates the attainment of walking skills and decreases the amount of support used for walking in young children with CP. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Feasibility of a 6-Month Yoga Program to Improve the Physical and Psychosocial Status of Persons with Multiple Sclerosis and their Family Members.

PubMed

Kahraman, Turhan; Ozdogar, Asiye Tuba; Yigit, Pinar; Hosgel, Ilknur; Mehdiyev, Zaur; Ertekin, Ozge; Ozakbas, Serkan

To the best of our knowledge, there has been no study on yoga that includes both persons with multiple sclerosis (MS) and their family members. Because yoga has therapeutic effects in both persons with MS and healthy persons, we hypothesized that it would be an effective method to improve not only the physical and psychosocial status but also the time persons with MS and their family members spend together. To examine the feasibility of a 6-month (long-term) yoga program to improve the physical and psychosocial status of persons with MS and their family members. Uncontrolled clinical trial. The protocol was developed at the Department of Neurology, Faculty of Medicine, and School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey. Persons with MS and healthy family members. Walking, balance, fatigue, health-related quality of life, depression, pain, and kinesiophobia. Yoga training was given once a week (at least 1h) for 6 months. The same assessors who assessed at baseline also performed the same assessments immediately after the end of the training (i.e., after 6 months). In total, 44 participants (27 persons with MS and 17 healthy family members) participated in the study. Twelve persons with MS and three healthy family members completed the 6-month yoga intervention. The completion rate for persons with MS and healthy subjects was 44.4% and 17.6%, respectively. In persons with MS, the mental dimension of health-related quality of life, walking speed, fatigue, and depression levels significantly improved after the yoga program (p < .05). However, there was no significant change in the self-reported walking impact, balance, pain, physical dimension of health-related quality of life, and kinesiophobia levels in the persons with MS (p > .05). This study suggests that a 6-month yoga program can improve the mental dimension of health-related quality of life, walking speed, fatigue, and depression in the persons with MS. However, the 6-month yoga program does not appear to be a feasible method to increase the time that persons with MS spend together with their family members. Copyright © 2018 Elsevier Inc. All rights reserved.

Experimental protocol of a randomized controlled clinical trial investigating exercise, subclinical atherosclerosis, and walking mobility in persons with multiple sclerosis.

PubMed

Griffith, Garett; Klaren, Rachel E; Motl, Robert W; Baynard, Tracy; Fernhall, Bo

2015-03-01

This randomized controlled trial (RCT) will investigate the effects of a home-based aerobic exercise training regimen (i.e., cycle ergometry) on subclinical atherosclerosis and walking mobility in persons with multiple sclerosis (MS) and minimal disability. This RCT will recruit 54 men and women who have an Expanded Disability Status Scale characteristic of the 1st stage of MS (i.e., 0-4.0) to participate in a 3 month exercise or stretching intervention, with assessments of subclinical atherosclerosis and walking mobility conducted at baseline, week 6 (midpoint), and week 12 (conclusion) of the program. The exercise intervention will consist of 3 days/week of cycling, with a gradual increase of duration followed by an increase in intensity across the 3 month period. The attention-control condition will incorporate stretching activities and will require the same contact time commitment as the exercise condition. Both study groups will participate in weekly video chat sessions with study personnel in order to monitor and track program adherence. Primary outcomes will consist of assessments of vascular structure and function, as well as several walking tasks. Additional outcomes will include questionnaires, cardiorespiratory fitness assessment, and a 1-week free-living physical activity assessment. This investigation will increase understanding of the role of aerobic exercise as part of a treatment plan for managing subclinical atherosclerosis and improving walking mobility persons in the 1st stage of MS. Overall, this study design has the potential to lead to effective aerobic exercise intervention strategies for this population and improve program adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

The effects of physical exercise on patients with Crohn's disease.

PubMed

Loudon, C P; Corroll, V; Butcher, J; Rawsthorne, P; Bernstein, C N

1999-03-01

Despite the suggested benefits of exercise training in the prevention and management of chronic diseases, few data exist regarding the safety of exercise in Crohn's disease and whether or not exercise may have beneficial effects on patients' health. We performed a pilot study to evaluate the effects of regular light-intensity exercise on sedentary patients with Crohn's disease. Sedentary patients with inactive or mildly active Crohn's disease were eligible for the study. A thrice-weekly, 12-wk walking program was supervised, although if subjects could not attend the group walking sessions they were allowed to walk on their own. Logbooks of performance were maintained, and individual exercise heart rate goals were established. Measures performed at baseline and at study completion included the Inflammatory Bowel Disease Stress Index, the Inflammatory Bowel Disease Quality of Life Score, the Harvey and Bradshaw Simple Index, the Canadian Aerobic Fitness Test, VO2 Max, and body mass index (BMI). Twelve subjects completed the 12-wk exercise program. Subjects walked an average of 2.9 sessions/wk, at an average of 32.6 min/session, and for an average distance of 3.5 km/session. Statistically significant improvements at study end were seen by all measures, with a trend toward reduction in BMI. No patient's disease flared during the study. Sedentary patients with Crohn's disease can tolerate low-intensity exercise of moderate duration without an exacerbation of symptoms. Twelve weeks of walking was adequate to elicit psychological and physical improvements and did not adversely affect disease activity.

Effects of exercise on brain activity during walking in older adults: a randomized controlled trial.

PubMed

Shimada, Hiroyuki; Ishii, Kenji; Makizako, Hyuma; Ishiwata, Kiichi; Oda, Keiichi; Suzukawa, Megumi

2017-05-30

Physical activity may preserve neuronal plasticity, increase synapse formation, and cause the release of hormonal factors that promote neurogenesis and neuronal function. Previous studies have reported enhanced neurocognitive function following exercise training. However, the specific cortical regions activated during exercise training remain largely undefined. In this study, we quantitatively and objectively evaluated the effects of exercise on brain activity during walking in healthy older adults. A total of 24 elderly women (75-83 years old) were randomly allocated to either an intervention group or a control group. Those in the intervention group attended 3 months of biweekly 90-min sessions focused on aerobic exercise, strength training, and physical therapy. We monitored changes in regional cerebral glucose metabolism during walking in both groups using positron emission tomography (PET) and [ 18 F]fluorodeoxyglucose (FDG). All subjects completed the 3-month experiment and the adherence to the exercise program was 100%. Compared with the control group, the intervention group showed a significantly greater step length in the right foot after 3 months of physical activity. The FDG-PET assessment revealed a significant post-intervention increase in regional glucose metabolism in the left posterior entorhinal cortex, left superior temporal gyrus, and right superior temporopolar area in the intervention group. Interestingly, the control group showed a relative increase in regional glucose metabolism in the left premotor and supplemental motor areas, left and right somatosensory association cortex, and right primary visual cortex after the 3-month period. We found no significant differences in FDG uptake between the intervention and control groups before vs. after the intervention. Exercise training increased activity in specific brain regions, such as the precuneus and entorhinal cortices, which play an important role in episodic and spatial memory. Further investigation is required to confirm whether alterations in glucose metabolism within these regions during walking directly promote physical and cognitive performance. UMIN-CTR ( UMIN000021829 ). Retrospectively registered 10 April 2016.

The effect of the inspiratory muscle training on functional ability in stroke patients.

PubMed

Jung, Nam-Jin; Na, Sang-Su; Kim, Seung-Kyu; Hwangbo, Gak

2017-11-01

[Purpose] This study was to find out an inspiratory muscle training (IMT) program therapeutic effects on stroke patients' functional ability. [Subjects and Methods] Twenty stroke patients were assigned to one of two groups: inspiratory muscle training (n=10), and control (n=10), randomization. The inspiratory muscle training participants undertook an exercise program for 30 minute per times, 5 times a week for 6 weeks. The investigator measured the patients' trunk impairment scale (TIS) and 6 minute walking test (6MW) for functional ability before and after IMT. [Results] The TIS appeared some significant differences in both groups before and after the training. The 6MW test showed some significant differences in the inspiratory muscle training group, but didn't show any significant difference in the control group. And the differences in both groups after depending the inspiratory muscle training were significantly found in the tests of TIS and 6MW test [Conclusion] The results showed that the inspiratory muscle training in stroke patients are correlated with the trunk stability and locomotion ability, suggesting that physical therapist must take into consideration the inspiratory muscle training, as well as functional training to improve physical function in stroke patients.

CONARC Training Workshop, Fort Gordon, Georgia, 5-7 October 1971. Volume I. General: Opening, Closing, and Dinner Sessions.

DTIC Science & Technology

1971-10-01

Jack and Bobby Kennedy, Jim Plunkett, George Jackson, the Beatles , Janice Joplin, and the growing number of men who have walked on the moon. It...just quit and turn the show over to these bright and energetic kids. That won’t work either because all of history shows us that the sense of what...charged by DA with FY 71 management of the motion picture/ television production program. History of Army-wide Training Films was traced to show support

Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery.

PubMed

Sullivan, Katherine J; Knowlton, Barbara J; Dobkin, Bruce H

2002-05-01

To investigate the effect of practice paradigms that varied treadmill speed during step training with body weight support in subjects with chronic hemiparesis after stroke. Randomized, repeated-measures pilot study with 1- and 3-month follow-ups. Outpatient locomotor laboratory. Twenty-four individuals with hemiparetic gait deficits whose walking speeds were at least 50% below normal. Participants were stratified by locomotor severity based on initial walking velocity and randomly assigned to treadmill training at slow (0.5mph), fast (2.0mph), or variable (0.5, 1.0, 1.5, 2.0mph) speeds. Participants received 20 minutes of training per session for 12 sessions over 4 weeks. Self-selected overground walking velocity (SSV) was assessed at the onset, middle, and end of training, and 1 and 3 months later. SSV improved in all groups compared with baseline (P<.001). All groups increased SSV in the 1-month follow-up (P<.01) and maintained these gains at the 3-month follow-up (P=.77). The greatest improvement in SSV across training occurred with fast training speeds compared with the slow and variable groups combined (P=.04). Effect size (ES) was large between fast compared with slow (ES=.75) and variable groups (ES=.73). Training at speeds comparable with normal walking velocity was more effective in improving SSV than training at speeds at or below the patient's typical overground walking velocity. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Efficacy of an Exercise Game Based on Kinect in Improving Physical Performances of Fall Risk Factors in Community-Dwelling Older Adults.

PubMed

Kayama, Hiroki; Okamoto, Kazuya; Nishiguchi, Shu; Yukutake, Taiki; Tanigawa, Takanori; Nagai, Koutatsu; Yamada, Minoru; Aoyama, Tomoki

2013-08-01

The purpose of this study was to demonstrate whether a 12-week program of training with dual-task Tai Chi (DTTC), which is a new concept game we developed using Kinect (Microsoft, Redmond, WA), would be effective in improving physical functions of fall risk factors. This study examined balance, muscle strength, locomotive ability, and dual-task ability in community-dwelling older adults (75.4±6.3 years) before and after 12 weeks of DTTC training (training group [TG]; n=32) or standardized training (control group [CG]; n=41). Primary end points were based on the difference in physical functions between the TG and the CG. Significant differences were observed between the two groups with significant group×time interaction for the following physical function measures: timed up-and-go (TUG) (P<0.01), one-leg standing (OLS) (P<0.05), and 5 chair stand (5-CS) (P<0.05). There were no significant differences among the other measures: 10-m walking time under standard conditions, manual-task conditions, and cognitive-task conditions, 10-m maximal walking time, and Functional Reach test scores. Thus, the scores of TUG, OLS, and 5-CS in the TG improved significantly with DTTC training compared with the CG. The results suggest that the DTTC training is effective in improving balance ability and mobility, which are risk factors for falls.

Making the Road by Walking: Using Role-Play and Instructor Feedback to Teach Basic Counseling Skills to Singaporean Trainee Educational Psychologists

ERIC Educational Resources Information Center

Kit, Phey Ling; Garces-Bacsal, Rhoda Myra; Burgetova, Kristina

2015-01-01

This study focused on the experiential learning experiences of eight trainee educational psychologists (school psychologists in the United States) from Singapore who participated in three role-play sessions during a two-day Basic Counseling Skills Training Program. Data collected from transcriptions of video-recorded sessions, a focus group…

Effects of Neuromuscular Training on the Rear-foot Angle Kinematics in Elite Women Field Hockey Players with Chronic Ankle Instability

PubMed Central

Kim, Eunkuk; Choi, Hokyung; Cha, Jung-Hoon; Park, Jong-Chul; Kim, Taegyu

2017-01-01

The aims of this study were to investigate the ankle position, the changes and persistence of ankle kinematics after neuromuscular training in athletes with chronic ankle instability (CAI). A total of 21 national women’s field hockey players participated (CAI = 12, control = 9). Ankle position at heel strike (HS), midstance (MS), and toe touch (TT) in the frontal plane during walking, running and landing were measured using 3D motion analysis. A 6-week neuromuscular training program was undertaken by the CAI group. Measurements of kinematic data for both groups were measured at baseline and the changes in kinematic data for CAI group were measured at 6 and 24 weeks. The kinematic data at HS during walking and running demonstrated that the magnitude of the eversion in the CAI group (−5.00° and −4.21°) was less than in the control group (−13.45°and −9.62°). The kinematic data at MS also exhibited less ankle eversion in the CAI group (−9.36° and −8.18°) than in the control group (−18.52° and −15.88°). Ankle positions at TT during landing were comparable between groups. Following the 6-week training, the CAI participants demonstrated a less everted ankle at HS during walking and running (−1.77° and −1.76°) compared to the previous positions. They also showed less ankle eversion at MS (−5.14° and −4.19°). Ankle orientation at TT changed significantly to an inverted ankle position (from −0.26° to 4.11°). The ankle kinematics were restored back to the previous positions at 24 weeks except for landing. It appeared that athletes with unstable ankle had a relatively inverted ankle position, and that 6-week neuromuscular training had an immediate effect on changing ankle orientation toward a less everted direction. The changed ankle kinematics seemed to persist during landing but not during walking and running. Key points Athletes with unstable ankles had a relatively inverted ankle position during the initial contact and midstance. Six-week neuromuscular training for unstable ankles had an immediate effect on changing ankle orientation toward a relatively more inverted direction. The changed ankle kinematics persisted during jump landing but not during walking and running. PMID:28344462

Leg surface electromyography patterns in children with neuro-orthopedic disorders walking on a treadmill unassisted and assisted by a robot with and without encouragement

PubMed Central

2013-01-01

Background Robot-assisted gait training and treadmill training can complement conventional physical therapy in children with neuro-orthopedic movement disorders. The aim of this study was to investigate surface electromyography (sEMG) activity patterns during robot-assisted gait training (with and without motivating instructions from a therapist) and unassisted treadmill walking and to compare these with physiological sEMG patterns. Methods Nine children with motor impairments and eight healthy children walked in various conditions: (a) on a treadmill in the driven gait orthosis Lokomat®, (b) same condition, with additional motivational instructions from a therapist, and (c) on the treadmill without assistance. sEMG recordings were made of the tibialis anterior, gastrocnemius lateralis, vastus medialis, and biceps femoris muscles. Differences in sEMG amplitudes between the three conditions were analyzed for the duration of stance and swing phase (for each group and muscle separately) using non-parametric tests. Spearman’s correlation coefficients illustrated similarity of muscle activation patterns between conditions, between groups, and with published reference trajectories. Results The relative duration of stance and swing phase differed between patients and controls, and between driven gait orthosis conditions and treadmill walking. While sEMG amplitudes were higher when being encouraged by a therapist compared to robot-assisted gait training without instructions (0.008 ≤ p-value ≤ 0.015), muscle activation patterns were highly comparable (0.648 ≤ Spearman correlation coefficients ≤ 0.969). In general, comparisons of the sEMG patterns with published reference data of over-ground walking revealed that walking in the driven gait orthosis could induce more physiological muscle activation patterns compared to unsupported treadmill walking. Conclusions Our results suggest that robotic-assisted gait training with therapeutic encouragement could appropriately increase muscle activity. Robotic-assisted gait training in general could induce physiological muscle activation patterns, which might indicate that this training exploits restorative rather than compensatory mechanisms. PMID:23867005

Design and Pilot Study of a Gait Enhancing Mobile Shoe.

PubMed

Handzic, Ismet; Barno, Eileen M; Vasudevan, Erin V; Reed, Kyle B

2011-12-01

Hemiparesis is a frequent and disabling consequence of stroke and can lead to asymmetric and inefficient walking patterns. Training on a split-belt treadmill, which has two separate treads driving each leg at a different speed, can correct such asymmetries post-stroke. However, the effects of split-belt treadmill training only partially transfer to everyday walking over ground and extended training sessions are required to achieve long-lasting effects. Our aim is to develop an alternative device, the Gait Enhancing Mobile Shoe (GEMS), that mimics the actions of the split-belt treadmill, but can be used during overground walking and in one's own home, thus enabling long-term training. The GEMS does not require any external power and is completely passive; all necessary forces are redirected from the natural forces present during walking. Three healthy subjects walked on the shoes for twenty minutes during which one GEMS generated a backward motion and the other GEMS generated a forward motion. Our preliminary experiments suggest that wearing the GEMS did cause subjects to modify coordination between the legs and these changes persisted when subjects returned to normal over-ground walking. The largest effects were observed in measures of temporal coordination (e.g., duration of double-support). These results suggest that the GEMS is capable of altering overground walking coordination in healthy controls and could potentially be used to correct gait asymmetries post-stroke.

Effects of physical guidance on short-term learning of walking on a narrow beam

PubMed Central

Domingo, Antoinette; Ferris, Daniel P.

2009-01-01

Physical guidance is often used in rehabilitation when teaching patients to re-learn movements. However, the effects of guidance on motor learning of complex skills, such as walking balance, are not clear. We tested four groups of healthy subjects that practiced walking on a narrow (1.27 cm) or wide (2.5 cm) treadmill-mounted balance beam, with or without physical guidance. Assistance was given by springs attached to a hip belt that applied restoring forces towards beam center. Subjects were evaluated while walking unassisted before and after training by calculating the number of times subjects stepped off of the beam per minute of successful walking on the beam (Failures per Minute). Subjects in Unassisted groups had greater performance improvements in walking balance from pre to post compared to subjects in Assisted groups. During training, Unassisted groups had more Failures per Minute than Assisted groups. Performance improvements were smaller in Narrow Beam groups than in Wide Beam groups. The Unassisted-Wide and Assisted-Narrow groups had similar Failures per Minute during training, but the Unassisted-Wide group had much greater performance gains after training. These results suggest that physical assistance can hinder motor learning of walking balance, assistance appears less detrimental for more difficult tasks, and task-specific dynamics are important to learning independent of error experience. PMID:19674900

Locomotor Adaptation Improves Balance Control, Multitasking Ability and Reduces the Metabolic Cost of Postural Instability

NASA Technical Reports Server (NTRS)

Bloomberg, J. J.; Peters, B. T.; Mulavara, A. P.; Brady, R. A.; Batson, C. D.; Miller, C. A.; Ploutz-Snyder, R. J.; Guined, J. R.; Buxton, R. E.; Cohen, H. S.

2011-01-01

During exploration-class missions, sensorimotor disturbances may lead to disruption in the ability to ambulate and perform functional tasks during the initial introduction to a novel gravitational environment following a landing on a planetary surface. The overall goal of our current project is to develop a sensorimotor adaptability training program to facilitate rapid adaptation to these environments. We have developed a unique training system comprised of a treadmill placed on a motion-base facing a virtual visual scene. It provides an unstable walking surface combined with incongruent visual flow designed to enhance sensorimotor adaptability. Greater metabolic cost incurred during balance instability means more physical work is required during adaptation to new environments possibly affecting crewmembers? ability to perform mission critical tasks during early surface operations on planetary expeditions. The goal of this study was to characterize adaptation to a discordant sensory challenge across a number of performance modalities including locomotor stability, multi-tasking ability and metabolic cost. METHODS: Subjects (n=15) walked (4.0 km/h) on a treadmill for an 8 -minute baseline walking period followed by 20-minutes of walking (4.0 km/h) with support surface motion (0.3 Hz, sinusoidal lateral motion, peak amplitude 25.4 cm) provided by the treadmill/motion-base system. Stride frequency and auditory reaction time were collected as measures of locomotor stability and multi-tasking ability, respectively. Metabolic data (VO2) were collected via a portable metabolic gas analysis system. RESULTS: At the onset of lateral support surface motion, subj ects walking on our treadmill showed an increase in stride frequency and auditory reaction time indicating initial balance and multi-tasking disturbances. During the 20-minute adaptation period, balance control and multi-tasking performance improved. Similarly, throughout the 20-minute adaptation period, VO2 gradually decreased following an initial increase after the onset of support surface motion. DISCUSSION: Resu lts confirmed that walking in discordant conditions not only compromises locomotor stability and the ability to multi-task, but comes at a quantifiable metabolic cost. Importantly, like locomotor stability and multi-tasking ability, metabolic expenditure while walking in discordant sensory conditions improved during adaptation. This confirms that sensorimotor adaptability training can benefit multiple performance parameters central to the successful completion of critical mission tasks.

Leader behaviors, group cohesion, and participation in a walking group program

PubMed Central

Izumi, Betty T.; Schulz, Amy J.; Mentz, Graciela; Israel, Barbara A.; Sand, Sharon L.; Reyes, Angela G.; Hoston, Bernadine; Richardson, Dawn; Gamboa, Cindy; Rowe, Zachary; Diaz, Goya

2015-01-01

Background Fewer than half of all U.S. adults meet the 2008 Physical Activity Guidelines. Leader behaviors and group cohesion have been associated with increased participation or adherence in sports team and exercise class settings. Physical activity interventions in community settings that encompass these factors may enhance intervention adherence. Purpose To examine the impact of Community Health Promoter leader behaviors and group cohesion on participation in a walking group intervention among racially/ethnically diverse adults in low-to-moderate income communities in Detroit, Mich. Design Data for the current study were drawn from the Walk Your Heart to Health (WYHH) data set. WYHH was a multi-site cluster randomized controlled study with a lagged intervention and outcome measurements at baseline, four, eight, and 32 weeks. Pooled survey data from both intervention arms is used for the current study. Data were analyzed between August 2013 and October 2014. Setting/participants A total of 603 non-Hispanic Black, non-Hispanic White, and Hispanic adults across five cohorts that began the 32-week WYHH intervention between March 2009 and October 2011. Intervention A 32-week long walking group program hosted by community- and faith-based organizations and facilitated by Community Health Promoters. Walking groups met three times per week for 90-minutes per session. To promote participation in or adherence to WYHH, Community Health Promoters used evidence-based strategies to facilitate group cohesion. Group members assumed increasing leadership responsibility for facilitating sessions over time. Main outcome measures Participation in WYHH as measured by consistency of attendance. Results Community Health Promoter leader behaviors were positively associated with participation in WYHH. Social but not task cohesion was significantly associated with consistent participation. Social cohesion may mediate the relationship between leader behaviors and walking group participation. Conclusions Providing leaders with training to build socially cohesive groups may help motivate individuals to continue participation in community-based physical activity programs. PMID:26094226

5K Run: 7-Week Training Schedule for Beginners

MedlinePlus

... This 5K training schedule incorporates a mix of running, walking and resting. This combination helps reduce the ... you'll gradually increase the amount of time running and reduce the amount of time walking. If ...

Does dual task training improve walking performance of older adults with concern of falling?

PubMed

Wollesen, B; Schulz, S; Seydell, L; Delbaere, K

2017-09-11

Older adults with concerns of falling show decrements of gait stability under single (ST) and dual task (DT) conditions. To compare the effects of a DT training integrating task managing strategies for independent living older adults with and without concern about falling (CoF) to a non-training control group on walking performance under ST and DT conditions. Single center parallel group single blind randomized controlled trial with group-based interventions (DT-managing balance training) compared to a control group (Ninety-five independent living older adults; 71.5 ± 5.2 years). A progressive DT training (12 sessions; 60 min each; 12 weeks) including task-managing strategies was compared to a non-training control group. group based intervention for independent living elderly in a gym. ST and DT walking (visual verbal Stroop task) were measured on a treadmill. Gait parameters (step length, step width, and gait line) and cognitive performance while walking were compared with a 2x2x2 Repeated Measures Analyses of Variance. Participants in the intervention group showed an increased step length under ST and DT conditions following the intervention, for both people with and without CoF compared to their respective control groups. Foot rolling movement and cognitive performance while walking however only improved in participants without CoF. The results showed that DT managing training can improve walking performance under ST and DT conditions in people with and without CoF. Additional treatment to directly address CoF, such as cognitive behavioural therapy, should be considered to further improve the cautious gait pattern (as evidenced by reduced foot rolling movements). The study was retrospectively registered in the German Clinical Trials Register (DRKS; Identification number DRKS00012382 , 11.05.2017).

Performance of a visuomotor walking task in an augmented reality training setting.

PubMed

Haarman, Juliet A M; Choi, Julia T; Buurke, Jaap H; Rietman, Johan S; Reenalda, Jasper

2017-12-01

Visual cues can be used to train walking patterns. Here, we studied the performance and learning capacities of healthy subjects executing a high-precision visuomotor walking task, in an augmented reality training set-up. A beamer was used to project visual stepping targets on the walking surface of an instrumented treadmill. Two speeds were used to manipulate task difficulty. All participants (n = 20) had to change their step length to hit visual stepping targets with a specific part of their foot, while walking on a treadmill over seven consecutive training blocks, each block composed of 100 stepping targets. Distance between stepping targets was varied between short, medium and long steps. Training blocks could either be composed of random stepping targets (no fixed sequence was present in the distance between the stepping targets) or sequenced stepping targets (repeating fixed sequence was present). Random training blocks were used to measure non-specific learning and sequenced training blocks were used to measure sequence-specific learning. Primary outcome measures were performance (% of correct hits), and learning effects (increase in performance over the training blocks: both sequence-specific and non-specific). Secondary outcome measures were the performance and stepping-error in relation to the step length (distance between stepping target). Subjects were able to score 76% and 54% at first try for lower speed (2.3 km/h) and higher speed (3.3 km/h) trials, respectively. Performance scores did not increase over the course of the trials, nor did the subjects show the ability to learn a sequenced walking task. Subjects were better able to hit targets while increasing their step length, compared to shortening it. In conclusion, augmented reality training by use of the current set-up was intuitive for the user. Suboptimal feedback presentation might have limited the learning effects of the subjects. Copyright © 2017 Elsevier B.V. All rights reserved.

Training to Facilitate Adaptation to Novel Sensory Environments

NASA Technical Reports Server (NTRS)

Bloomberg, J. J.; Peters, B. T.; Mulavara, A. P.; Brady, R. A.; Batson, C. D.; Ploutz-Snyder, R. J.; Cohen, H. S.

2010-01-01

After spaceflight, the process of readapting to Earth s gravity causes locomotor dysfunction. We are developing a gait training countermeasure to facilitate adaptive responses in locomotor function. Our training system is comprised of a treadmill placed on a motion-base facing a virtual visual scene that provides an unstable walking surface combined with incongruent visual flow designed to train subjects to rapidly adapt their gait patterns to changes in the sensory environment. The goal of our present study was to determine if training improved both the locomotor and dual-tasking ability responses to a novel sensory environment and to quantify the retention of training. Subjects completed three, 30-minute training sessions during which they walked on the treadmill while receiving discordant support surface and visual input. Control subjects walked on the treadmill without any support surface or visual alterations. To determine the efficacy of training, all subjects were then tested using a novel visual flow and support surface movement not previously experienced during training. This test was performed 20 minutes, 1 week, and 1, 3, and 6 months after the final training session. Stride frequency and auditory reaction time were collected as measures of postural stability and cognitive effort, respectively. Subjects who received training showed less alteration in stride frequency and auditory reaction time compared to controls. Trained subjects maintained their level of performance over 6 months. We conclude that, with training, individuals became more proficient at walking in novel discordant sensorimotor conditions and were able to devote more attention to competing tasks.

The immediate effects of robot-assistance on energy consumption and cardiorespiratory load during walking compared to walking without robot-assistance: a systematic review.

PubMed

Lefeber, Nina; Swinnen, Eva; Kerckhofs, Eric

2017-10-01

The integration of sufficient cardiovascular stress into robot-assisted gait (RAG) training could combine the benefits of both RAG and aerobic training. The aim was to summarize literature data on the immediate effects of RAG compared to walking without robot-assistance on metabolic-, cardiorespiratory- and fatigue-related parameters. PubMed and Web of Science were searched for eligible articles till February 2016. Means, SDs and significance values were extracted. Effect sizes were calculated. Fourteen studies were included, concerning 155 participants (85 healthy subjects, 39 stroke and 31 spinal cord injury patients), 9 robots (2 end-effectors, 1 treadmill-based and 6 wearable exoskeletons), and 7 outcome parameters (mostly oxygen consumption and heart rate). Overall, metabolic and cardiorespiratory parameters were lower during RAG compared to walking without robot-assistance (moderate to large effect sizes). In healthy subjects, when no body-weight support (BWS) was provided, RAG with an end-effector device was more energy demanding than walking overground (p > .05, large effect sizes). Generally, results suggest that RAG is less energy-consuming and cardiorespiratory stressful than walking without robot-assistance, but results depend on factors such as robot type, walking speed, BWS and effort. Additional research is needed to draw firm conclusions. Implications for Rehabilitation Awareness of the energy consumption and cardiorespiratory load of robot-assisted gait (RAG) training is important in the rehabilitation of (neurological) patients with impaired cardiorespiratory fitness and patients who are at risk of cardiovascular diseases. On the other hand, the integration of sufficient cardiometabolic stress in RAG training could combine the effects of both RAG and aerobic training. Energy consumption and cardiorespiratory load during walking with robot-assistance seems to depend on factors such as robot type, walking speed, body-weight support or amount of effort. These parameters could be adjusted in RAG rehabilitation to make RAG more or less energy-consuming and cardiorespiratory stressful. Overall, short duration exoskeleton walking seems less energy-consuming and cardiorespiratory stressful than walking without robot-assistance. This might implicate that the exercise intensity is safe for (neurological) patients at risk of cardiovascular diseases. How this changes in extended walking time is unclear.

Implementation of interval walking training in patients with type 2 diabetes in Denmark: rationale, design, and baseline characteristics

PubMed Central

Ried-Larsen, Mathias; Thomsen, Reimar W; Berencsi, Klara; Brinkløv, Cecilie F; Brøns, Charlotte; Valentiner, Laura S; Karstoft, Kristian; Langberg, Henning; Vaag, Allan A; Pedersen, Bente K; Nielsen, Jens S

2016-01-01

Promoting physical activity is a first-line choice of treatment for patients with type 2 diabetes (T2D). However, there is a need for more effective tools and technologies to facilitate structured lifestyle interventions and to ensure a better compliance, sustainability, and health benefits of exercise training in patients with T2D. The InterWalk initiative and its innovative application (app) for smartphones described in this study were developed by the Danish Centre for Strategic Research in T2D aiming at implementing, testing, and validating interval walking in patients with T2D in Denmark. The interval walking training approach consists of repetitive 3-minute cycles of slow and fast walking with simultaneous intensity guiding, based on the exercise capacity of the user. The individual intensity during slow and fast walking is determined by a short initial self-conducted and audio-guided fitness test, which combined with automated audio instructions strives to motivate the individual to adjust the intensity to the predetermined individualized walking intensities. The InterWalk app data are collected prospectively from all users and will be linked to the unique Danish nationwide databases and administrative registries, allowing extensive epidemiological studies of exercise in patients with T2D, such as the level of adherence to InterWalk training and long-term effectiveness surveys of important health outcomes, including cardiovascular morbidity and mortality. Currently, the InterWalk app has been downloaded by >30,000 persons, and the achieved epidemiological data quality is encouraging. Of the 9,466 persons providing personal information, 80% of the men and 62% women were overweight or obese (body mass index ≥25). The InterWalk project represents a contemporary technology-driven public health approach to monitor real-life exercise adherence and to propagate improved health through exercise intervention in T2D and in the general population. PMID:27354828

Electromechanical-assisted training for walking after stroke.

PubMed

Mehrholz, Jan; Thomas, Simone; Werner, Cordula; Kugler, Joachim; Pohl, Marcus; Elsner, Bernhard

2017-05-10

Electromechanical- and robotic-assisted gait-training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007. To investigate the effects of automated electromechanical- and robotic-assisted gait-training devices for improving walking after stroke. We searched the Cochrane Stroke Group Trials Register (last searched 9 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 8), MEDLINE in Ovid (1950 to 15 August 2016), Embase (1980 to 15 August 2016), CINAHL (1982 to 15 August 2016), AMED (1985 to 15 August 2016), Web of Science (1899 to 16 August 2016), SPORTDiscus (1949 to 15 September 2012), the Physiotherapy Evidence Database (PEDro) (searched 16 August 2016), and the engineering databases COMPENDEX (1972 to 16 November 2012) and Inspec (1969 to 26 August 2016). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted authors in an effort to identify further published, unpublished, and ongoing trials. We included all randomised controlled trials and randomised controlled cross-over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical- and robotic-assisted gait training versus normal care. Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted the data. The primary outcome was the proportion of participants walking independently at follow-up. We included 36 trials involving 1472 participants in this review update. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 1.94, 95% confidence interval (CI) 1.39 to 2.71; P < 0.001; I² = 8%; moderate-quality evidence) but did not significantly increase walking velocity (mean difference (MD) 0.04 m/s, 95% CI 0.00 to 0.09; P = 0.08; I² = 65%; low-quality evidence) or walking capacity (MD 5.84 metres walked in 6 minutes, 95% CI -16.73 to 28.40; P = 0.61; I² = 53%; very low-quality evidence). The results must be interpreted with caution because 1) some trials investigated people who were independent in walking at the start of the study, 2) we found variations between the trials with respect to devices used and duration and frequency of treatment, and 3) some trials included devices with functional electrical stimulation. Our planned subgroup analysis suggested that people in the acute phase may benefit, but people in the chronic phase may not benefit from electromechanical-assisted gait training. Post hoc analysis showed that people who are non-ambulatory at intervention onset may benefit, but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk, but significant differences were found between devices in terms of walking velocity. People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that seven patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase III trials undertaken to address specific questions about the most effective frequency and duration of electromechanical-assisted gait training as well as how long any benefit may last.

Conflicting results of robot-assisted versus usual gait training during postacute rehabilitation of stroke patients: a randomized clinical trial

PubMed Central

Taveggia, Giovanni; Borboni, Alberto; Mulé, Chiara; Negrini, Stefano

2016-01-01

Robot gait training has the potential to increase the effectiveness of walking therapy. Clinical outcomes after robotic training are often not superior to conventional therapy. We evaluated the effectiveness of a robot training compared with a usual gait training physiotherapy during a standardized rehabilitation protocol in inpatient participants with poststroke hemiparesis. This was a randomized double-blind clinical trial in a postacute physical and rehabilitation medicine hospital. Twenty-eight patients, 39.3% women (72±6 years), with hemiparesis (<6 months after stroke) receiving a conventional treatment according to the Bobath approach were assigned randomly to an experimental or a control intervention of robot gait training to improve walking (five sessions a week for 5 weeks). Outcome measures included the 6-min walk test, the 10 m walk test, Functional Independence Measure, SF-36 physical functioning and the Tinetti scale. Outcomes were collected at baseline, immediately following the intervention period and 3 months following the end of the intervention. The experimental group showed a significant increase in functional independence and gait speed (10 m walk test) at the end of the treatment and follow-up, higher than the minimal detectable change. The control group showed a significant increase in the gait endurance (6-min walk test) at the follow-up, higher than the minimal detectable change. Both treatments were effective in the improvement of gait performances, although the statistical analysis of functional independence showed a significant improvement in the experimental group, indicating possible advantages during generic activities of daily living compared with overground treatment. PMID:26512928

Reducing The Cost of Transport and Increasing Walking Distance After Stroke: A Randomized Controlled Trial on Fast Locomotor Training Combined With Functional Electrical Stimulation

PubMed Central

Awad, Louis N.; Reisman, Darcy S.; Pohlig, Ryan T.; Binder-Macleod, Stuart A.

2015-01-01

Background Neurorehabilitation efforts have been limited in their ability to restore walking function after stroke. Recent work has demonstrated proof-of-concept for a Functional Electrical Stimulation (FES)-based combination therapy designed to improve poststroke walking by targeting deficits in paretic propulsion. Objectives To determine the effects on the energy cost of walking (EC) and long-distance walking ability of locomotor training that combines fast walking with FES to the paretic ankle musculature (FastFES). Methods Fifty participants >6 months poststroke were randomized to 12 weeks of gait training at self-selected speeds (SS), fast speeds (Fast), or FastFES. Participants’ 6-Minute Walk Test (6MWT) distance and EC at comfortable (EC-CWS) and fast (EC-Fast) walking speeds were measured pretraining, posttraining, and at a 3-month follow-up. A reduction in EC-CWS, independent of changes in speed, was the primary outcome. Also evaluated were group differences in the number of 6MWT responders and moderation by baseline speed. Results When compared with SS and Fast, FastFES produced larger reductions in EC (p’s ≤0.03). FastFES produced reductions of 24% and 19% in EC-CWS and EC-Fast (p’s <0.001), whereas neither Fast nor SS influenced EC. Between-group 6MWT differences were not observed; however, 73% of FastFES and 68% of Fast participants were responders, in contrast to 35% of SS participants. Conclusions Combining fast locomotor training with FES is an effective approach to reducing the high EC of persons poststroke. Surprisingly, differences in 6MWT gains were not observed between groups. Closer inspection of the 6MWT and EC relationship and elucidation of how reduced EC may influence walking-related disability is warranted. PMID:26621366

HAL® exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients.

PubMed

Sczesny-Kaiser, Matthias; Höffken, Oliver; Aach, Mirko; Cruciger, Oliver; Grasmücke, Dennis; Meindl, Renate; Schildhauer, Thomas A; Schwenkreis, Peter; Tegenthoff, Martin

2015-08-20

Reorganization in the sensorimotor cortex accompanied by increased excitability and enlarged body representations is a consequence of spinal cord injury (SCI). Robotic-assisted bodyweight supported treadmill training (BWSTT) was hypothesized to induce reorganization and improve walking function. To assess whether BWSTT with hybrid assistive limb® (HAL®) exoskeleton affects cortical excitability in the primary somatosensory cortex (S1) in SCI patients, as measured by paired-pulse somatosensory evoked potentials (ppSEP) stimulated above the level of injury. Eleven SCI patients took part in HAL® assisted BWSTT for 3 months. PpSEP were conducted before and after this training period, where the amplitude ratios (SEP amplitude following double pulses - SEP amplitude following single pulses) were assessed and compared to eleven healthy control subjects. To assess improvement in walking function, we used the 10-m walk test, timed-up-and-go test, the 6-min walk test, and the lower extremity motor score. PpSEPs were significantly increased in SCI patients as compared to controls at baseline. Following training, ppSEPs were increased from baseline and no longer significantly differed from controls. Walking parameters also showed significant improvements, yet there was no significant correlation between ppSEP measures and walking parameters. The findings suggest that robotic-assisted BWSTT with HAL® in SCI patients is capable of inducing cortical plasticity following highly repetitive, active locomotive use of paretic legs. While there was no significant correlation of excitability with walking parameters, brain areas other than S1 might reflect improvement of walking functions. EEG and neuroimaging studies may provide further information about supraspinal plastic processes and foci in SCI rehabilitation.

Applicability of a new robotic walking aid in a patient with cerebral palsy. Case report.

PubMed

Smania, N; Gandolfi, M; Marconi, V; Calanca, A; Geroin, C; Piazza, S; Bonetti, P; Fiorini, P; Cosentino, A; Capelli, C; Conte, D; Bendinelli, M; Munari, D; Ianes, P; Fiaschi, A; Picelli, A

2012-03-01

Gait training with the help of assistive technological devices is an innovative field of research in neurological rehabilitation. Most of the available gait training devices do not allow free movement in the environment, which would be the most suitable natural and motivating condition for training children with neurological gait impairment. To evaluate the potential applicability of a new robotic walking aid as a tool for gait training in non-ambulatory children with Cerebral Palsy. Single case study Outpatient regimen A 11-years-old child unable to stand and walk independently as a result of spastic tetraplegic cerebral palsy (CP). The experimental device was a newly actuated version of a dynamic combined walking and standing aid (NF-Walker®) available in the market which was modified by means of two pneumatic artificial muscles driven by a foot-switch inserted in the shoes. The child was tested at baseline (while maintaining the standing position aided by the non-actuated NF-Walker®) and in the experimental condition (while using the actuated robotic aid). The outcome measures were: 2-minute walking test, 10-metre walking test, respiratory and heart parameters, energy cost of locomotion. At baseline, the child was unable to perform any autonomous form of locomotion. When assisted by the actuated aid (i.e. during the experimental condition), the child was successful in moving around in his environment. His performance was 19.63 m in the 2-minute walking test and 64 s in the 10-metre walking test. Respiratory and heart parameters were higher than healthy age-matched children both at baseline and in the experimental condition. The energy cost of gait, which was not valuable in the baseline condition, was significantly higher than normality during the experimental condition. The new robotic walking aid may help children suffering from CP with severe impairment of gait to move around in their environment. This new robotic walking device may have a potential impact in stimulating the development and in training of gait in children with neurological gait impairment. Future studies are warranted in order to test this hypothesis.

Safety and efficacy of at-home robotic locomotion therapy in individuals with chronic incomplete spinal cord injury: a prospective, pre-post intervention, proof-of-concept study.

PubMed

Rupp, Rüdiger; Schließmann, Daniel; Plewa, Harry; Schuld, Christian; Gerner, Hans Jürgen; Weidner, Norbert; Hofer, Eberhard P; Knestel, Markus

2015-01-01

The compact Motorized orthosis for home rehabilitation of Gait (MoreGait) was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semi-supine position and provides feedback about deviations from the reference walking pattern. Prospective, pre-post intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI). Twenty-five (5 tetraplegia, 20 paraplegia) participants with chronic (mean time since injury: 5.8 ± 5.4 (standard deviation, SD) years) sensorimotor iSCI (7 ASIA Impairment Scale (AIS) C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II): Interquartile range 9 to 16) completed the training (45 minutes / day, at least 4 days / week, 8 weeks). Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy. After therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100%) for both self-selected (Mean 139.4% ± 35.5% (SD)) and maximum (Mean 143.1% ± 40.6% (SD)) speed conditions as well as the endurance estimated with the six-minute walk test (Mean 166.6% ± 72.1% (SD)). One device-related adverse event (pressure sore on the big toe) occurred in over 800 training sessions. Home-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation. German Clinical Trials Register (DKRS) DRKS00005587.

Synergistic association of changes in serum uric acid and triglycerides with changes in insulin resistance after walking exercise in community-dwelling older women.

PubMed

Kawamoto, Ryuichi; Katoh, Takeaki; Ninomiya, Daisuke; Kumagi, Teru; Abe, Masanori; Kohara, Katsuhiko

2016-05-01

Serum uric acid (SUA) and triglyceride (TG) levels are strongly correlated with insulin resistance; however, the association after a walking exercise program in community-dwelling older women has not been investigated. The present study included 100 postmenopausal women (mean ± standard deviation, 68 ± 7 years) from a rural village in Japan. The Nordic walking program of 120 min per week was performed for 12 weeks. Before and after the intervention, SUA, TG, various relevant factors and homeostasis model assessment of insulin resistance (HOMA-IR) were measured. Multivariate linear regression analysis showed that baseline TG and γ-glutamyltransferase (GGT) were significantly associated with baseline HOMA-IR. After the 12-week training program, changes in TG, SUA and GGT were significantly associated with changes in HOMA-IR. In addition to their direct associations, we observed a synergistic association between changes in TG and SUA and changes in HOMA-IR. Participants were divided into three groups (tertiles) according to changes in TG and SUA. The tertiles of changes in SUA correlated significantly with changes in HOMA-IR in participants in the tertile with the greatest decrease in TG (r = 0.525, p = 0.001), but not in the other two tertiles of change in TG (r = 0.049, p = 0.699). There was a significant interaction between SUA and TG for changes in HOMA-IR (β = 0.281, p = 0.005). These results suggest that changes in TG and SUA are synergistic factors associated with changes in insulin resistance after a 12-week walking exercise program in community-dwelling older women.

Individualized treadmill and strength training for chronic stroke rehabilitation: effects of imbalance.

PubMed

Al-Jarrah, Muhammed; Shaheen, Samira; Harries, Netta; Kissani, Najib; Molteni, Franco; Bar Haim, Simona

2014-01-01

Stroke survivors often have significant walking limitations and are at high risk for falling. Treadmill training, as a rehabilitation approach in stroke survivors, and its relationship to balance ability has not been widely studied. The main goal of this study was to investigate the effectiveness of an individualized treadmill-strength training protocol on functional outcomes in chronic stroke survivors. Thirty adult participants with chronic stroke were recruited from 1 European and 4 Middle Eastern countries. Each completed 36 sessions of treadmill-strength training. The rehabilitation protocol was individualized according to each patient's cardiovascular fitness. Ten-meter walk test (10MWT), Berg Balance Scale (BBS), and 6-minute walk test (6MWT) were measured before (T0) and after training (T1) and 6 months later (T2). Paired t tests were used to test differences with training (T1 - T0) and retention after training (T2 - T1). Increases in all 3 measures from T0 to T1 were significant. There were no changes in 10MWT and BBS from T1 to T2, but 6MWT tended to increase. Separate analyses for subjects with BBS scores <41 at T0 demonstrated comparatively greater improvements from T0 to T1 than in those with BBS scores ≯40. Those with low scores also significantly increased from T1 to T2 in both walk tests. These findings suggest that a protocol combining treadmill with strength training has beneficial long-term effects on functional walking measures after chronic stroke, especially in patients who initially have low balance ability.

Comparative study of two different respiratory training protocols in elderly patients with chronic obstructive pulmonary disease.

PubMed

Mehani, Sherin Hassan Mohammed

2017-01-01

The aim of the present study was to compare threshold inspiratory muscle training (IMT) and expiratory muscle training (EMT) in elderly male patients with moderate degree of COPD. Forty male patients with moderate degree of COPD were recruited for this study. They were randomly divided into two groups: the IMT group who received inspiratory training with an intensity ranging from 15% to 60% of their maximal inspiratory pressure, and the EMT group who received expiratory training with an equal intensity which was adjusted according to the maximal expiratory pressure. Both groups received training three times per week for 2 months, in addition to their prescribed medications. Both IMT and EMT groups showed a significant improvement in forced vital capacity, forced expiratory volume in the first second, forced expiratory volume in the first second% from the predicted values, and forced vital capacity% from the predicted value, with no difference between the groups. Both types of training resulted in a significant improvement in blood gases (SaO 2 %, PaO 2 , PaCO 2 , and HCO 3 ), with the inspiratory muscle group showing the best results. Both groups showed a significant improvement in the 6-min walking distance: an increase of about 25% in the inspiratory muscle group and about 2.5% in the expiratory muscle group. Both IMT and EMT must be implemented in pulmonary rehabilitation programs in order to achieve improvements in pulmonary function test, respiratory muscle strength, blood oxygenation, and 6-min walking distance.

Pilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals.

PubMed

Vancini, Rodrigo Luiz; Rayes, Angeles Bonal Rosell; Lira, Claudio Andre Barbosa de; Sarro, Karine Jacon; Andrade, Marilia Santos

2017-12-01

To compare the effects of Pilates and walking on quality of life, depression, and anxiety levels. Sixty-three overweight/obese participants were randomly divided into: control (n = 20), walking (n = 21), and Pilates (n = 22) groups. Pilates and walking groups attended eight weeks of 60-minute exercise sessions three times per week. Quality of life, depression, and state- and trait-anxiety levels were evaluated before and after eight weeks of training. Scores of quality of life, depression, and trait-anxiety improved in the Pilates and walking groups. State-anxiety levels improved only in the walking group. Pilates and walking positively impact quality of life, depression and anxiety. The Pilates method could be used as an alternative to improve mood disorders in overweight/obese individuals.

Mall Walking Program Environments, Features, and Participants: A Scoping Review.

PubMed

Farren, Laura; Belza, Basia; Allen, Peg; Brolliar, Sarah; Brown, David R; Cormier, Marc L; Janicek, Sarah; Jones, Dina L; King, Diane K; Marquez, David X; Rosenberg, Dori E

2015-08-13

Walking is a preferred and recommended physical activity for middle-aged and older adults, but many barriers exist, including concerns about safety (ie, personal security), falling, and inclement weather. Mall walking programs may overcome these barriers. The purpose of this study was to summarize the evidence on the health-related value of mall walking and mall walking programs. We conducted a scoping review of the literature to determine the features, environments, and benefits of mall walking programs using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). The inclusion criteria were articles that involved adults aged 45 years or older who walked in indoor or outdoor shopping malls. Exclusion criteria were articles that used malls as laboratory settings or focused on the mechanics of walking. We included published research studies, dissertations, theses, conference abstracts, syntheses, nonresearch articles, theoretical papers, editorials, reports, policy briefs, standards and guidelines, and nonresearch conference abstracts and proposals. Websites and articles written in a language other than English were excluded. We located 254 articles on mall walking; 32 articles met our inclusion criteria. We found that malls provided safe, accessible, and affordable exercise environments for middle-aged and older adults. Programmatic features such as program leaders, blood pressure checks, and warm-up exercises facilitated participation. Individual benefits of mall walking programs included improvements in physical, social, and emotional well-being. Limited transportation to the mall was a barrier to participation. We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs' reach, effectiveness, adoption, implementation, and maintenance.

Changes in Function After a 6-Month Walking Intervention in Patients With Intermittent Claudication Who Are Obese or Nonobese.

PubMed

Addison, Odessa; Ryan, Alice S; Prior, Steven J; Katzel, Leslie I; Kundi, Rishi; Lal, Brajesh K; Gardner, Andrew W

Both obesity and peripheral artery disease (PAD) limit function and may work additively to reduce mobility. The purpose of this study was to compare the effects of a 6-month, center-based walking program on mobility function between adults who are weight-stable obese and nonobese with PAD. This is a secondary data analysis of 2 combined studies taken from previous work. Fifty-three adults with PAD and intermittent claudication participated in 6 months of treadmill training or standard of care. Patients were divided into 4 groups for analyses: exercise nonobese (Ex), exercise obese (ExO), standard-of-care nonobese (SC), and standard-of-care obese (SCO). Mobility was assessed by a standardized treadmill test to measure claudication onset time (COT) and peak walking time (PWT) as well as the distance walked during a 6-minute walk distance (6MWD) test. There was a significant (P < .001) interaction (intervention × obesity) effect on 6MWD, wherein both exercise groups improved (Ex = 7%, ExO = 16%; P < .02), the SC group did not change (0.9%; P > .05), and the SCO group tended to decline (-18%; P = .06). Both exercise intervention groups significantly improved COT (Ex = 92%, ExO = 102%; P < .01) and PWT (Ex = 54%, ExO = 103%; P < .001). There was no change (P > .05) in either standard-of-care group. Individuals who are obese and nonobese with PAD made similar improvements after a 6-month, center-based walking program. However, patients who are obese with PAD and do not exercise may be susceptible to greater declines in mobility. Exercise may be particularly important in patients who are obese with PAD to avoid declines in mobility.

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

PubMed Central

Field-Fote, Edelle C.; Yang, Jaynie F.; Basso, D. Michele; Gorassini, Monica A.

2017-01-01

Abstract Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans. PMID:27673569

Clinical impact of exercise in patients with peripheral arterial disease.

PubMed

Novakovic, Marko; Jug, Borut; Lenasi, Helena

2017-08-01

Increasing prevalence, high morbidity and mortality, and decreased health-related quality of life are hallmarks of peripheral arterial disease. About one-third of peripheral arterial disease patients have intermittent claudication with deleterious effects on everyday activities, such as walking. Exercise training improves peripheral arterial disease symptoms and is recommended as first line therapy for peripheral arterial disease. This review examines the effects of exercise training beyond improvements in walking distance, namely on vascular function, parameters of inflammation, activated hemostasis and oxidative stress, and quality of life. Exercise training not only increases walking distance and physiologic parameters in patients with peripheral arterial disease, but also improves the cardiovascular risk profile by helping patients achieve better control of hypertension, hyperglycemia, obesity and dyslipidemia, thus further reducing cardiovascular risk and the prevalence of coexistent atherosclerotic diseases. American guidelines suggest supervised exercise training, performed for a minimum of 30-45 min, at least three times per week, for at least 12 weeks. Walking is the most studied exercise modality and its efficacy in improving cardiovascular parameters in patients with peripheral arterial disease has been extensively proven. As studies have shown that supervised exercise training improves walking performance, cardiovascular parameters and quality of life in patients with peripheral arterial disease, it should be encouraged and more often prescribed.

Treadmill Training with HAL Exoskeleton-A Novel Approach for Symptomatic Therapy in Patients with Limb-Girdle Muscular Dystrophy-Preliminary Study.

PubMed

Sczesny-Kaiser, Matthias; Kowalewski, Rebecca; Schildhauer, Thomas A; Aach, Mirko; Jansen, Oliver; Grasmücke, Dennis; Güttsches, Anne-Katrin; Vorgerd, Matthias; Tegenthoff, Martin

2017-01-01

Purpose: Exoskeletons have been developed for rehabilitation of patients with walking impairment due to neurological disorders. Recent studies have shown that the voluntary-driven exoskeleton HAL® (hybrid assistive limb) can improve walking functions in spinal cord injury and stroke. The aim of this study was to assess safety and effects on walking function of HAL® supported treadmill therapy in patients with limb-girdle muscular dystrophy (LGMD). Materials and Methods: Three LGMD patients received 8 weeks of treadmill training with HAL® 3 times a week. Outcome parameters were 10-meter walk test (10 MWT), 6-minute walk test, and timed-up-and-go test (TUG). Parameters were assessed pre and post training and 6 weeks later (follow-up). Results: All patients completed the therapy without adverse reactions and reported about improvement in endurance. Improvements in outcome parameters after 8 weeks could be demonstrated. Persisting effects were observed after 6 weeks for the 10 MWT and TUG test (follow-up). Conclusions: HAL® treadmill training in LGMD patients can be performed safely and enables an intensive highly repetitive locomotor training. All patients benefitted from this innovative method. Upcoming controlled studies with larger cohorts should prove its effects in different types of LGMD and other myopathies.

Treadmill Training with HAL Exoskeleton—A Novel Approach for Symptomatic Therapy in Patients with Limb-Girdle Muscular Dystrophy—Preliminary Study

PubMed Central

Sczesny-Kaiser, Matthias; Kowalewski, Rebecca; Schildhauer, Thomas A.; Aach, Mirko; Jansen, Oliver; Grasmücke, Dennis; Güttsches, Anne-Katrin; Vorgerd, Matthias; Tegenthoff, Martin

2017-01-01

Purpose: Exoskeletons have been developed for rehabilitation of patients with walking impairment due to neurological disorders. Recent studies have shown that the voluntary-driven exoskeleton HAL® (hybrid assistive limb) can improve walking functions in spinal cord injury and stroke. The aim of this study was to assess safety and effects on walking function of HAL® supported treadmill therapy in patients with limb-girdle muscular dystrophy (LGMD). Materials and Methods: Three LGMD patients received 8 weeks of treadmill training with HAL® 3 times a week. Outcome parameters were 10-meter walk test (10 MWT), 6-minute walk test, and timed-up-and-go test (TUG). Parameters were assessed pre and post training and 6 weeks later (follow-up). Results: All patients completed the therapy without adverse reactions and reported about improvement in endurance. Improvements in outcome parameters after 8 weeks could be demonstrated. Persisting effects were observed after 6 weeks for the 10 MWT and TUG test (follow-up). Conclusions: HAL® treadmill training in LGMD patients can be performed safely and enables an intensive highly repetitive locomotor training. All patients benefitted from this innovative method. Upcoming controlled studies with larger cohorts should prove its effects in different types of LGMD and other myopathies. PMID:28848377

Effects of walking or resistance training on weight loss maintenance in obese, middle-aged men: a randomized trial.

PubMed

Borg, P; Kukkonen-Harjula, K; Fogelholm, M; Pasanen, M

2002-05-01

To investigate whether walking or resistance training improves weight maintenance after weight loss when added to dietary counselling. Two months' weight reduction with very-low-energy-diet (VLED) followed by randomization into three groups (control, walking, resistance training) for 6 months' weight maintenance (WM) program and 23 months' unsupervised follow-up. During VLED and WM all groups received similar dietary counselling. The main inclusion criteria were BMI >30 kg/m(2), waist>100 cm and physical inactivity (exercise < or = once a week). Ninety healthy, obese (mean BMI 32.9 kg/m(2) and waist 112.5 cm), 35-50 y-old men started the study and 68 were measured at the end of the study. Weight and body composition assessed by underwater weighing. Exercise diaries and dietary records to assess energy balance. During VLED the mean body weight decreased from 106.0 (s.d. 9.9) kg to 91.7 (9.4) kg. Weight was regained mostly during follow-up and in the end of the study the mean weight in groups was 99.9-102.0 kg. Exercise training did not improve short or long-term weight maintenance when compared to the control group. However, resistance training attenuated the regain of body fat mass during WM (P=0.0l), but not during follow-up. In the combined groups the estimated total energy expenditure (EE) of reported physical activity was associated with less weight regain during WM. EE of 10.1 MJ/week was associated with maintaining weight after weight loss. EE of physical activity tended to decrease after WM in exercise groups due to poor long-term adherence to prescribed exercise. Energy intake seemed to increase during follow-up. Exercise training of moderate dose did not seem to improve long-term weight maintenance because of poor adherence to prescribed exercise.

Astronaut Catherine G. Coleman during WETF training

NASA Image and Video Library

1994-01-12

S94-25956 (April 1994) --- Astronaut Catherine G. Coleman, mission specialist, wearing a high-fidelity training version of an Extravehicular Mobility Unit (EMU), trains for a contingency space walk at the Johnson Space Center?s (JSC) Weightless Environment Training Facility (WET-F). Coleman has recently been named as one of seven crew members for the U.S. Microgravity Laboratory (USML-2) mission. The 25-feet deep pool is used to train astronauts for mission specific space walk chores as well as for contingency Extravehicular Activity (EVA) tasks.

Study on Walking Training System using High-Performance Shoes constructed with Rubber Elements

NASA Astrophysics Data System (ADS)

Hayakawa, Y.; Kawanaka, S.; Kanezaki, K.; Doi, S.

2016-09-01

The number of accidental falls has been increasing among the elderly as society has aged. The main factor is a deteriorating center of balance due to declining physical performance. Another major factor is that the elderly tend to have bowlegged walking and their center of gravity position of the body tend to swing from side to side during walking. To find ways to counteract falls among the elderly, we developed walking training system to treat the gap in the center of balance. We also designed High-Performance Shoes that showed the status of a person's balance while walking. We also produced walk assistance from the insole in which insole stiffness corresponded to human sole distribution could be changed to correct the person's walking status. We constructed our High- Performances Shoes to detect pressure distribution during walking. Comparing normal sole distribution patterns and corrected ones, we confirmed that our assistance system helped change the user's posture, thereby reducing falls among the elderly.

Muscle function in aged women in response to a water-based exercises program and progressive resistance training.

PubMed

Bento, Paulo Cesar Barauce; Rodacki, André Luiz Felix

2015-11-01

The purpose of the present study was to determine the effects of a water-based exercise program on muscle function compared with regular high-intensity resistance training. Older women (n = 87) were recruited from the local community. The inclusion criteria were, to be aged 60 years or older, able to walk and able to carry out daily living activities independently. Participants were randomly assigned to one of the following groups: water-based exercises (WBG), resistance training (RTG) or control (CG). The experimental groups carried out 12 weeks of an excise program performed on water or on land. The dynamic strength, the isometric peak, and rate of torque development for the lower limbs were assessed before and after interventions. The water-based program provided a similar improvement in dynamic strength in comparison with resistance training. The isometric peak torque increased around the hip and ankle joints in the water-based group, and around the knee joint in the resistance-training group (P < 0.05). The rate of torque development increased only in the water-based group around the hip extensors muscles (P < 0.05). Water-based programs constitute an attractive alternative to promote relevant strength gains using moderate loads and fast speed movements, which were also effective to improve the capacity to generate fast torques. © 2014 Japan Geriatrics Society.

Action observation training of community ambulation for improving walking ability of patients with post-stroke hemiparesis: a randomized controlled pilot trial.

PubMed

Park, Hyun-Ju; Oh, Duck-Won; Choi, Jong-Duk; Kim, Jong-Man; Kim, Suhn-Yeop; Cha, Yong-Jun; Jeon, Su-Jin

2017-08-01

To investigate the effects of action observation training involving community-based ambulation for improving walking ability after stroke. Randomized, controlled pilot study. Inpatient rehabilitation hospital. A total of 25 inpatients with post-stroke hemiparesis were randomly assigned to either the experimental group ( n = 12) or control group ( n = 13). Subjects of the experimental group watched video clips demonstrating four-staged ambulation training with a more complex environment factor for 30 minutes, three times a week for four weeks. Meanwhile, subjects of the control group watched video clips, which showed different landscape pictures. Walking function was evaluated before and after the four-week intervention using a 10-m walk test, community walk test, activities-specific balance confidence scale, and spatiotemporal gait measures. Changes in the values for the 10-m walk test (0.17 ±0.19 m/s vs. 0.05 ±0.08 m/s), community walk test (-151.42 ±123.82 seconds vs. 67.08 ±176.77 seconds), and activities-specific balance confidence (6.25 ±5.61 scores vs. 0.72 ±2.24 scores) and the spatiotemporal parameters (i.e. stride length (19.00 ±11.34 cm vs. 3.16 ±11.20 cm), single support (5.87 ±5.13% vs. 0.25 ±5.95%), and velocity (15.66 ±12.34 cm/s vs. 2.96 ±10.54 cm/s)) indicated a significant improvement in the experimental group compared with the control group. In the experimental group, walking function and ambulation confidence was significantly different between the pre- and post-intervention, whereas the control group showed a significant difference only in the 10-m walk test. Action observation training of community ambulation may be favorably used for improving walking function of patients with post-stroke hemiparesis.

Mall Walking Program Environments, Features, and Participants: A Scoping Review

PubMed Central

Belza, Basia; Allen, Peg; Brolliar, Sarah; Brown, David R.; Cormier, Marc L.; Janicek, Sarah; Jones, Dina L.; King, Diane K.; Marquez, David X.; Rosenberg, Dori E.

2015-01-01

Introduction Walking is a preferred and recommended physical activity for middle-aged and older adults, but many barriers exist, including concerns about safety (ie, personal security), falling, and inclement weather. Mall walking programs may overcome these barriers. The purpose of this study was to summarize the evidence on the health-related value of mall walking and mall walking programs. Methods We conducted a scoping review of the literature to determine the features, environments, and benefits of mall walking programs using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). The inclusion criteria were articles that involved adults aged 45 years or older who walked in indoor or outdoor shopping malls. Exclusion criteria were articles that used malls as laboratory settings or focused on the mechanics of walking. We included published research studies, dissertations, theses, conference abstracts, syntheses, nonresearch articles, theoretical papers, editorials, reports, policy briefs, standards and guidelines, and nonresearch conference abstracts and proposals. Websites and articles written in a language other than English were excluded. Results We located 254 articles on mall walking; 32 articles met our inclusion criteria. We found that malls provided safe, accessible, and affordable exercise environments for middle-aged and older adults. Programmatic features such as program leaders, blood pressure checks, and warm-up exercises facilitated participation. Individual benefits of mall walking programs included improvements in physical, social, and emotional well-being. Limited transportation to the mall was a barrier to participation. Conclusion We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs’ reach, effectiveness, adoption, implementation, and maintenance. PMID:26270743

Safety and efficacy of exercise training in adults with Pompe disease: evalution of endurance, muscle strength and core stability before and after a 12 week training program.

PubMed

van den Berg, Linda E M; Favejee, Marein M; Wens, Stephan C A; Kruijshaar, Michelle E; Praet, Stephan F E; Reuser, Arnold J J; Bussmann, Johannes B J; van Doorn, Pieter A; van der Ploeg, Ans T

2015-07-19

Pompe disease is a proximal myopathy. We investigated whether exercise training is a safe and useful adjuvant therapy for adult Pompe patients, receiving enzyme replacement therapy. Training comprised 36 sessions of standardized aerobic, resistance and core stability exercises over 12 weeks. Before and after, the primary outcome measures safety, endurance (aerobic exercise capacity and distance walked on the 6 min walk test) and muscle strength, and secondary outcome measures core stability, muscle function and body composition, were evaluated. Of 25 patients enrolled, 23 successfully completed the training. Improvements in endurance were shown by increases in maximum workload capacity (110 W before to 122 W after training, [95 % CI of the difference 6 · 0 to 19 · 7]), maximal oxygen uptake capacity (69 · 4 % and 75 · 9 % of normal, [2 · 5 to 10 · 4]), and maximum walking distance (6 min walk test: 492 meters and 508, [-4 · 4 to 27 · 7] ). There were increases in muscle strength of the hip flexors (156 · 4 N to 180 · 7 N [1 · 6 to 13 · 6) and shoulder abductors (143 · 1 N to 150 · 7 N [13 · 2 to 35 · 2]). As an important finding in secondary outcome measures the number of patients who were able to perform the core stability exercises rose, as did the core stability balancing time (p < 0.05, for all four exercises). Functional tests showed small reductions in the time needed to climb four steps (2 · 4 sec to 2 · 1, [- 0 · 54 to -0 · 04 ]) and rise to standing position (5 · 8 sec to 4 · 8, [-2 · 0 to 0 · 0]), while time to run, the quick motor function test results and body composition remained unchanged. Our study shows that a combination of aerobic, strength and core stability exercises is feasible, safe and beneficial to adults with Pompe disease.

Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy.

PubMed

Willerslev-Olsen, Maria; Lorentzen, Jakob; Nielsen, Jens Bo

2014-01-01

Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems. Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP? Seventeen children with CP (4-14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking. Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking. Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.

Effects of a Training Program Involving Body Cooling on Physical and Cognitive Capacities and Quality of Life in Multiple Sclerosis Patients: A Pilot Study.

PubMed

Gonzales, Benoit; Chopard, Gilles; Charry, Benjamin; Berger, Eric; Tripard, Julien; Magnin, Eloi; Groslambert, Alain

2017-01-01

Two methods using exercise and body cooling could influence the well-being of patients with multiple sclerosis (PwMS). The aim of this study was to determine whether wearing a cooling vest during a physical training program could increase the cognitive and physical capacities and quality of life in PwMS. Eighteen PwMS (49.6 ± 8 years; Expanded Disability Status Score 5.0 ± 1.0) were randomly assigned to a cooling or control group. PwMS underwent a 7-week physical training program. In the cooling group, PwMS wore a cooling vest during each training session, whereas in the control group, PwMS wore a cotton T-shirt. Before and after the training program, both groups completed the Isaacs Set Test (IST), Trail Making Test A-B (TMT A-B), SEP-59, Multidimensional Fatigue Inventory and performed a 6-minute walk test (6MWT). The cooling group showed significantly (p < 0.05) improved performance for IST, TMT A and 6MWT. Their emotional well-being and cognitive functions investigated in SEP-59 were significantly (p < 0.05) improved, and general and physical fatigue significantly (p < 0.05) decreased. This physical training program combined with a cooling strategy could have a significant positive influence on both cognitive and physical performances, perceived fatigue and emotional well-being in heat-sensitive PwMS. © 2017 S. Karger AG, Basel.

Physical exercises for breast cancer survivors: effects of 10 weeks of training on upper limb circumferences

PubMed Central

Di Blasio, Andrea; Morano, Teresa; Bucci, Ines; Di Santo, Serena; D’Arielli, Alberto; Castro, Cristina Gonzalez; Cugusi, Lucia; Cianchetti, Ettore; Napolitano, Giorgio

2016-01-01

[Purpose] The aims of this study were to verify the effects on upper limb circumferences and total body extracellular water of 10 weeks of Nordic Walking (NW) and Walking (W), both alone and combined with a series of exercises created for breast cancer survivors, the ISA method. [Subjects and Methods] Twenty breast cancer survivors were randomly assigned to 4 different training groups and evaluated for upper limb circumferences, total body and extracellular water. [Results] The breast cancer survivors who performed NW, alone and combined with the ISA method, and Walking combined with the ISA method (but not alone) showed significantly reduced arm and forearm circumferences homolateral to the surgical intervention. [Conclusion] For breast cancer survivors, NW, alone and combined with the ISA method, and Walking combined with the ISA method should be prescribed to prevent the onset and to treat light forms of upper limb lymphedema because Walking training practiced alone had no significant effect on upper limb circumference reduction. PMID:27821934

Building Community: Stakeholder Perspectives on Walking in Malls and Other Venues.

PubMed

Belza, Basia; Miyawaki, Christina E; Allen, Peg; King, Diane K; Marquez, David X; Jones, Dina L; Janicek, Sarah; Rosenberg, Dori; Brown, David R

2017-10-01

Mall walking has been a popular physical activity for decades. However, little is known about why mall managers support these programs or why adults choose to walk. Our study aim was to describe mall walking programs from the perspectives of walkers, managers, and leaders. Twenty-eight walkers, 16 walking program managers, and six walking program leaders from five states participated in a telephone or in-person semi-structured interview (N = 50). Interview guides were developed using a social-ecological model. Interviews were recorded, transcribed verbatim, and analyzed thematically. All informants indicated satisfaction with their program and environmental features. Differences in expectations were noted in that walkers wanted a safe, clean, and social place whereas managers and leaders felt a need to provide programmatic features. Given the favorable walking environments in malls, there is an opportunity for public health professionals, health care organizations, and providers of aging services to partner with malls to promote walking.

Effects of eccentric-focused and conventional resistance training on strength and functional capacity of older adults.

PubMed

Dias, Caroline Pieta; Toscan, Rafael; de Camargo, Mainara; Pereira, Evelyn Possobom; Griebler, Nathália; Baroni, Bruno Manfredini; Tiggemann, Carlos Leandro

2015-10-01

The aim of the study was to assess the effect of eccentric training using a constant load with longer exposure time at the eccentric phase on knee extensor muscle strength and functional capacity of elderly subjects in comparison with a conventional resistance training program. Twenty-six healthy elderly women (age = 67 ± 6 years) were randomly assigned to an eccentric-focused training group (ETG; n = 13) or a conventional training group (CTG; n = 13). Subjects underwent 12 weeks of resistance training twice a week. For the ETG, concentric and eccentric phases were performed using 1.5 and 4.5 s, respectively, while for CTG, each phase lasted 1.5 s. Maximum dynamic strength was assessed by the one-repetition maximum (1RM) test in the leg press and knee extension exercises, and for functional capacity, subjects performed specific tests (6-m walk test, timed up-and-go test, stair-climbing test, and chair-rising test). Both groups improved knee extension 1RM (24-26 %; p = 0.021), timed up-and-go test (11-16 %; p < 0.001), 6-m walk test (9-12 %; p = 0.004), stair-climbing test (8-13 %; p = 0.007), and chair-rising test (15-16 %; p < 0.001), but there was no significant difference between groups. In conclusion, the strategy of increasing the exposure time at the eccentric phase of movement using the same training volume and intensity does not promote different adaptations in strength or functional capacity compared to conventional resistance training in elderly woman.

One day of motor training with amphetamine impairs motor recovery following spinal cord injury.

PubMed

Wong, Jamie K; Steward, Oswald

2012-02-01

It has previously been reported that a single dose of amphetamine paired with training on a beam walking task can enhance locomotor recovery following brain injury (Feeney et al., 1982). Here, we investigated whether this same drug/training regimen could enhance functional recovery following either thoracic (T9) or cervical (C5) spinal cord injury. Different groups of female Sprague-Dawley rats were trained on a beam walking task, and in a straight alley for assessment of hindlimb locomotor recovery using the BBB locomotor scale. For rats that received C5 hemisections, forelimb grip strength was assessed using a grip strength meter. Three separate experiments assessed the consequences of training rats on the beam walking task 24 h following a thoracic lateral hemisection with administration of either amphetamine or saline. Beginning 1 h following drug administration, rats either received additional testing/retraining on the beam hourly for 6 h, or they were returned to their home cages without further testing/retraining. Rats with thoracic spinal cord injuries that received amphetamine in conjunction with testing/retraining on the beam at 1 day post injury (DPI) exhibited significantly impaired recovery on the beam walking task and BBB. Rats with cervical spinal cord injuries that received training with amphetamine also exhibited significant impairments in beam walking and locomotion, as well as impairments in gripping and reaching abilities. Even when administered at 14 DPI, the drug/training regimen significantly impaired reaching ability in cervical spinal cord injured rats. Impairments were not seen in rats that received amphetamine without training. Histological analyses revealed that rats that received training with amphetamine had significantly larger lesions than saline controls. These data indicate that an amphetamine/training regimen that improves recovery after cortical injury has the opposite effect of impairing recovery following spinal cord injury because early training with amphetamine increases lesion severity. Copyright © 2011 Elsevier Inc. All rights reserved.

An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial.

PubMed

Shnayderman, Ilana; Katz-Leurer, Michal

2013-03-01

To assess the effect of aerobic walking training as compared to active training, which includes muscle strengthening, on functional abilities among patients with chronic low back pain. Randomized controlled clinical trial with blind assessors. Outpatient clinic. Fifty-two sedentary patients, aged 18-65 years with chronic low back pain. Patients who were post surgery, post trauma, with cardiovascular problems, and with oncological disease were excluded. Experimental 'walking' group: moderate intense treadmill walking; control 'exercise' group: specific low back exercise; both, twice a week for six weeks. Six-minute walking test, Fear-Avoidance Belief Questionnaire, back and abdomen muscle endurance tests, Oswestry Disability Questionnaire, Low Back Pain Functional Scale (LBPFS). Significant improvements were noted in all outcome measures in both groups with non-significant difference between groups. The mean distance in metres covered during 6 minutes increased by 70.7 (95% confidence interval (CI) 12.3-127.7) in the 'walking' group and by 43.8 (95% CI 19.6-68.0) in the 'exercise' group. The trunk flexor endurance test showed significant improvement in both groups, increasing by 0.6 (95% CI 0.0-1.1) in the 'walking' group and by 1.1 (95% CI 0.3-1.8) in the 'exercise' group. A six-week walk training programme was as effective as six weeks of specific strengthening exercises programme for the low back.

Feasibility and effects of patient-cooperative robot-aided gait training applied in a 4-week pilot trial

PubMed Central

2012-01-01

Background Functional training is becoming the state-of-the-art therapy approach for rehabilitation of individuals after stroke and spinal cord injury. Robot-aided treadmill training reduces personnel effort, especially when treating severely affected patients. Improving rehabilitation robots towards more patient-cooperative behavior may further increase the effects of robot-aided training. This pilot study aims at investigating the feasibility of applying patient-cooperative robot-aided gait rehabilitation to stroke and incomplete spinal cord injury during a therapy period of four weeks. Short-term effects within one training session as well as the effects of the training on walking function are evaluated. Methods Two individuals with chronic incomplete spinal cord injury and two with chronic stroke trained with the Lokomat gait rehabilitation robot which was operated in a new, patient-cooperative mode for a period of four weeks with four training sessions of 45 min per week. At baseline, after two and after four weeks, walking function was assessed with the ten meter walking test. Additionally, muscle activity of the major leg muscles, heart rate and the Borg scale were measured under different walking conditions including a non-cooperative position control mode to investigate the short-term effects of patient-cooperative versus non-cooperative robot-aided gait training. Results Patient-cooperative robot-aided gait training was tolerated well by all subjects and performed without difficulties. The subjects trained more actively and with more physiological muscle activity than in a non-cooperative position-control mode. One subject showed a significant and relevant increase of gait speed after the therapy, the three remaining subjects did not show significant changes. Conclusions Patient-cooperative robot-aided gait training is feasible in clinical practice and overcomes the main points of criticism against robot-aided gait training: It enables patients to train in an active, variable and more natural way. The limited number of subjects in this pilot trial does not permit valid conclusions on the effect of patient-cooperative robot-aided gait training on walking function. A large, possibly multi-center randomized controlled clinical trial is required to shed more light on this question. PMID:22650320

[Effect of supervised exercise training on walking speed, claudication distance and quality of life in peripheral arterial disease].

PubMed

Wenkstetten-Holub, Alfa; Kandioler-Honetz, Elisabeth; Kraus, Ingrid; Müller, Rudolf; Kurz, Robert Wolfgang

2012-08-01

Aim of the study was to evaluate the effects of supervised exercise training for peripheral arterial disease (PAD) on walking speed, claudication distance and quality of life. Ninety-four patients in stage IIa/IIb according to Fontaine underwent a six-month exercise training at the Center for Outpatient Rehabilitation Vienna (ZAW). Walking speed and Absolute Claudication Distance (ACD) improved significantly (p < 0,001 and p = 0,007 respectively). Increase of the Initial Claudication Distance (ICD) did not reach statistical significance (p = 0,14). Quality of life, as assessed by the questionnaire "PLC" manifested no significant change. The exercise training achieved considerable effects on walking speed and claudication distance. Despite these improvements, patient's quality of life revealed no relevant change. This outcome could be explained by the fact that aspects of physical functioning relevant to patients with claudicatio intermittens may be underrepresented in the PLC-questionnaire core module.

Nordic Walking Can Be Incorporated in the Exercise Prescription to Increase Aerobic Capacity, Strength, and Quality of Life for Elderly: A Systematic Review and Meta-Analysis.

PubMed

Bullo, Valentina; Gobbo, Stefano; Vendramin, Barbara; Duregon, Federica; Cugusi, Lucia; Di Blasio, Andrea; Bocalini, Danilo Sales; Zaccaria, Marco; Bergamin, Marco; Ermolao, Andrea

2018-04-01

The aim of this systematic review and meta-analysis was to summarize and analyze the effects of Nordic Walking on physical fitness, body composition, and quality of life in the elderly. Keyword "Nordic Walking" associated with "elderly" AND/OR "aging" AND/OR "old subjects" AND/OR "aged" AND/OR "older adults" were used in the online database MEDLINE, Embase, PubMed, Scopus, PsycINFO, and SPORTDiscus. Only studies written in English language and published in peer-reviewed journals were considered. A meta-analysis was performed and effect sizes calculated. Fifteen studies were identified; age of participants ranged from 60 to 92 years old. Comparing with a sedentary group, effect sizes showed that Nordic Walking was able to improve dynamic balance (0.30), functional balance (0.62), muscle strength of upper (0.66) and lower limbs (0.43), aerobic capacity (0.92), cardiovascular outcomes (0.23), body composition (0.30), and lipid profile (0.67). It seemed that Nordic Walking had a negative effect on static balance (-0.72). Comparing with a walking (alone) training, effect sizes showed that Nordic Walking improved the dynamic balance (0.30), flexibility of the lower body (0.47), and quality of life (0.53). Walking training was more effective in improving aerobic capacity (-0.21). Comparing Nordic Walking with resistance training, effect sizes showed that Nordic Walking improved dynamic balance (0.33), muscle strength of the lower body (0.39), aerobic capacity (0.75), flexibility of the upper body (0.41), and the quality of life (0.93). Nordic Walking can be considered as a safe and accessible form of aerobic exercise for the elderly population, able to improve cardiovascular outcomes, muscle strength, balance ability, and quality of life.

Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy.

PubMed

Morrison, Steven; Colberg, Sheri R; Parson, Henri K; Vinik, Aaron I

2014-01-01

For older adults with type 2 diabetes (T2DM), declines in balance and walking ability are risk factors for falls, and peripheral neuropathy magnifies this risk. Exercise training may improve balance, gait and reduce the risk of falling. This study investigated the effects of 12weeks of aerobic exercise training on walking, balance, reaction time and falls risk metrics in older T2DM individuals with/without peripheral neuropathy. Adults with T2DM, 21 without (DM; age 58.7±1.7years) and 16 with neuropathy (DM-PN; age 58.9±1.9years), engaged in either moderate or intense supervised exercise training thrice-weekly for 12weeks. Pre/post-training assessments included falls risk (using the physiological profile assessment), standing balance, walking ability and hand/foot simple reaction time. Pre-training, the DM-PN group had higher falls risk, slower (hand) reaction times (232 vs. 219ms), walked at a slower speed (108 vs. 113cm/s) with shorter strides compared to the DM group. Following training, improvements in hand/foot reaction times and faster walking speed were seen for both groups. While falls risk was not significantly reduced, the observed changes in gait, reaction time and balance metrics suggest that aerobic exercise of varying intensities is beneficial for improving dynamic postural control in older T2DM adults with/without neuropathy. Copyright © 2014 Elsevier Inc. All rights reserved.

Kinematic and EMG Responses to Pelvis and Leg Assistance Force during Treadmill Walking in Children with Cerebral Palsy

PubMed Central

Kim, Janis; Arora, Pooja; Zhang, Yunhui

2016-01-01

Treadmill training has been used for improving locomotor function in children with cerebral palsy (CP), but the functional gains are relatively small, suggesting a need to improve current paradigms. The understanding of the kinematic and EMG responses to forces applied to the body of subjects during treadmill walking is crucial for improving current paradigms. The objective of this study was to determine the kinematics and EMG responses to the pelvis and/or leg assistance force. Ten children with spastic CP were recruited to participate in this study. A controlled assistance force was applied to the pelvis and/or legs during stance and swing phase of gait through a custom designed robotic system during walking. Muscle activities and spatial-temporal gait parameters were measured at different loading conditions during walking. In addition, the spatial-temporal gait parameters during overground walking before and after treadmill training were also collected. Applying pelvis assistance improved step height and applying leg assistance improved step length during walking, but applying leg assistance also reduced muscle activation of ankle flexor during the swing phase of gait. In addition, step length and self-selected walking speed significantly improved after one session of treadmill training with combined pelvis and leg assistance. PMID:27651955

Treadmill sideways gait training with visual blocking for patients with brain lesions.

PubMed

Kim, Tea-Woo; Kim, Yong-Wook

2014-09-01

[Purpose] The aim of this study was to verify the effect of sideways treadmill training with and without visual blocking on the balance and gait function of patients with brain lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in this study. They were divided into two groups: an experimental group (12 subjects) and a control group (12 subjects). [Methods] Each group executed a treadmill training session for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the treadmill was performed with visual blocking by the experimental group and with normal vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function. It was used to measure walking speed, walking distance, step length, and stance time on each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were used as balance measures. [Results] The sideways gait training with visual blocking group showed significantly improved walking speed, walking distance, step length, and stance time on each foot after training; FTSST and TUG times also significantly improved after training in the experimental group. Compared to the control group, the experimental group showed significant increases in stance time on each foot. [Conclusion] Sideways gait training on a treadmill with visual blocking performed by patients with brain lesions significantly improved their balance and gait function.

Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial.

PubMed

Rolland, Yves; Pillard, Fabien; Klapouszczak, Adrian; Reynish, Emma; Thomas, David; Andrieu, Sandrine; Rivière, Daniel; Vellas, Bruno

2007-02-01

To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). Randomized, controlled trial. Five nursing homes. One hundred thirty-four ambulatory patients with mild to severe AD. Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

Effects of Dual-Task Management and Resistance Training on Gait Performance in Older Individuals: A Randomized Controlled Trial.

PubMed

Wollesen, Bettina; Mattes, Klaus; Schulz, Sören; Bischoff, Laura L; Seydell, L; Bell, Jeffrey W; von Duvillard, Serge P

2017-01-01

Background: Dual-task (DT) training is a well-accepted modality for fall prevention in older adults. DT training should include task-managing strategies such as task switching or task prioritization to improve gait performance under DT conditions. Methods: We conducted a randomized controlled trial to evaluate a balance and task managing training (BDT group) in gait performance compared to a single task (ST) strength and resistance training and a control group, which received no training. A total of 78 older individuals (72.0 ± 4.9 years) participated in this study. The DT group performed task managing training incorporating balance and coordination tasks while the ST group performed resistance training only. Training consisted of 12 weekly sessions, 60 min each, for 12 weeks. We assessed the effects of ST and BDT training on walking performance under ST and DT conditions in independent living elderly adults. ST and DT walking (visual verbal Stroop task) were measured utilizing a treadmill at self-selected walking speed (mean for all groups: 4.4 ± 1 km h -1 ). Specific gait variables, cognitive performance, and fear of falling were compared between all groups. > Results: Training improved gait performance for step length ( p < 0.001) and gait-line (ST: p < 0.01; DT p < 0.05) in both training groups. The BDT training group showed greater improvements in step length ( p < 0.001) and gait-line ( p < 0.01) during DT walking but did not have changes in cognitive performance. Both interventions reduced fear of falling ( p < 0.05). Conclusion: Implementation of task management strategies into balance and strength training in our population revealed a promising modality to prevent falls in older individuals. Trial registration: German register of clinical trials DRKS00012382.

[Effects of Acupuncture Intervention Combined with Rehabilitation on Standing-balance-walking Ability in Stroke Patients].

PubMed

Chu, Jia-mei; Bao, Ye-hua; Zhu, Min

2015-12-01

To observe the influence of acupuncture stimulation of lateral side of Tianzhu (para-BL 10), electroacupuncture (EA) stimulation of scalp-point Balance Area (MS 14), Motor Area (MS 6) and body acupoints combined with rehabilitation training on standing-balance and walking ability in stroke patients. A total of 145 stroke inpatients were randomly assigned to rehabilitation group (n=48), routine acupuncture group (n=49) and para-BL10 group (n = 48). Patients of the rehabilitation group received balance training and routine rehabilitation training treatment, those of the routine acupuncture group received acupuncture stimulation of scalp-points (MS 14, MS 6), body acupoints, balance training and routine rehabilitation training,and those of the para-BL10 group received acupuncture stimulation of lateral side of BL 10 combined with scalp-points of MS 14 and MS 6 and body acupoints, and balance training and routine rehabilitation training. The treatment was conducted once daily, 5 times per week, 8 weeks altogether. The patients' balancing function, lower-limb motor function and walking ability were assessed using Berg Balance Scale (BBS), Sheikh Trunk Control Ability Scale(STCAS), Fugl-Meyer Assessment Scale (FMAS), and Holden Functional Ambulation Classification (FAC), respectively. After 4 and 8 weeks' treatment, the scores of BBS, STCAS, FMAS and FAC in patients of the rehabilitation, routine acupuncture and para-BL10 groups were significantly increased and 10 meters-walking time obviously reduced in comparison with pre-treatment in the same one group (P<0.01). The effects of acupuncture stimulation of para-BL 10 were considerably better than both rehabilitation and routine acupuncture groups in raising BBS, STCAS, FMAS and FAC scores and in reducing 10 m-walking time (P<0.05). Acupuncture stimulation of lateral side of BL 10 combined with scalp-points has a significant benefit for stroke patients in standing-balance ability and walking ability.

Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis.

PubMed

Lloyd, Megan; Skelton, Dawn A; Mead, Gillian E; Williams, Brian; van Wijck, Frederike

2018-06-19

Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors. Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework. Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%. Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

Effect of a virtual reality-enhanced exercise protocol after coronary artery bypass grafting.

PubMed

Chuang, Tien-Yow; Sung, Wen-Hsu; Chang, Hwa-Ann; Wang, Ray-Yau

2006-10-01

Virtual reality (VR) technology has gained importance in many areas of medicine. Knowledge concerning the application and the influence of VR-enhanced exercise programs is limited for patients receiving coronary artery bypass grafting. The purpose of this study was to evaluate the effect of a virtual "country walk" on the number of sessions necessary to reach cardiac rehabilitation goals in patients undergoing coronary artery bypass grafting. Twenty subjects who were seen for cardiac rehabilitation between January and June 2004 comprised the study sample. The protocol for this study included an initial maximum graded exercise tolerance test, given to determine the subsequent training goals for the subject, followed by biweekly submaximal endurance training sessions. All subjects were assigned by lot to 1 of 2 submaximal endurance training programs, one (group 2) with and the other (group 1) without the added VR environment. In all other respects, the 2 programs were identical. Each training session lasted for 30 minutes and was carried out twice per week for about 3 months. The primary outcome measures were maximum load during the work sessions, target oxygen consumption, target heart rate (beats per minute), and number of training sessions required to reach rehabilitation goals. By the end of 20 training sessions, only 4 of the 10 control subjects had reached the heart rate target goal of 85% their maximum heart rate. In contrast, 9 of the 10 subjects in the VR program had attained this goal by 9 or fewer training sessions. When target metabolic cost (75% peak oxygen consumption) was used as the training goal, all 10 subjects in the VR program had reached this target after 2 training sessions (or, in some cases, 1 training session), but not until training session 15 did a cumulative number of 9 control subjects reach this goal. These study outcomes clearly support the notion that incorporating a VR environment into cardiac rehabilitation programs will accelerate maximum recovery of patients' cardiovascular function.

Long-term training modifies the modular structure and organization of walking balance control

PubMed Central

Allen, Jessica L.

2015-01-01

How does long-term training affect the neural control of movements? Here we tested the hypothesis that long-term training leading to skilled motor performance alters muscle coordination during challenging, as well as nominal everyday motor behaviors. Using motor module (a.k.a., muscle synergy) analyses, we identified differences in muscle coordination patterns between professionally trained ballet dancers (experts) and untrained novices that accompanied differences in walking balance proficiency assessed using a challenging beam-walking test. During beam walking, we found that experts recruited more motor modules than novices, suggesting an increase in motor repertoire size. Motor modules in experts had less muscle coactivity and were more consistent than in novices, reflecting greater efficiency in muscle output. Moreover, the pool of motor modules shared between beam and overground walking was larger in experts compared with novices, suggesting greater generalization of motor module function across multiple behaviors. These differences in motor output between experts and novices could not be explained by differences in kinematics, suggesting that they likely reflect differences in the neural control of movement following years of training rather than biomechanical constraints imposed by the activity or musculoskeletal structure and function. Our results suggest that to learn challenging new behaviors, we may take advantage of existing motor modules used for related behaviors and sculpt them to meet the demands of a new behavior. PMID:26467521

Long-term training modifies the modular structure and organization of walking balance control.

PubMed

Sawers, Andrew; Allen, Jessica L; Ting, Lena H

2015-12-01

How does long-term training affect the neural control of movements? Here we tested the hypothesis that long-term training leading to skilled motor performance alters muscle coordination during challenging, as well as nominal everyday motor behaviors. Using motor module (a.k.a., muscle synergy) analyses, we identified differences in muscle coordination patterns between professionally trained ballet dancers (experts) and untrained novices that accompanied differences in walking balance proficiency assessed using a challenging beam-walking test. During beam walking, we found that experts recruited more motor modules than novices, suggesting an increase in motor repertoire size. Motor modules in experts had less muscle coactivity and were more consistent than in novices, reflecting greater efficiency in muscle output. Moreover, the pool of motor modules shared between beam and overground walking was larger in experts compared with novices, suggesting greater generalization of motor module function across multiple behaviors. These differences in motor output between experts and novices could not be explained by differences in kinematics, suggesting that they likely reflect differences in the neural control of movement following years of training rather than biomechanical constraints imposed by the activity or musculoskeletal structure and function. Our results suggest that to learn challenging new behaviors, we may take advantage of existing motor modules used for related behaviors and sculpt them to meet the demands of a new behavior. Copyright © 2015 the American Physiological Society.

Anti-gravity training improves walking capacity and postural balance in patients with muscular dystrophy.

PubMed

Berthelsen, Martin Peter; Husu, Edith; Christensen, Sofie Bouschinger; Prahm, Kira Philipsen; Vissing, John; Jensen, Bente Rona

2014-06-01

Recent studies in patients with muscular dystrophies suggest positive effects of aerobic and strength training. These studies focused training on using bicycle ergometers and conventional strength training, which precludes more severely affected patients from participating, because of their weakness. We investigated the functional effects of combined aerobic and strength training in patients with Becker and limb-girdle muscular dystrophies with knee muscle strength levels as low as 3% of normal strength. Eight patients performed 10 weeks of aerobic and strength training on an anti-gravity treadmill, which offered weight support up to 80% of their body weight. Six minute walking distance, dynamic postural balance, and plasma creatine kinase were assessed 10 weeks prior to training, immediately before training and after 10 weeks of training. Training elicited an improvement of walking distance by 8±2% and dynamic postural balance by 13±4%, indicating an improved physical function. Plasma creatine kinase remained unchanged. These results provide evidence that a combination of aerobic and strength training during anti-gravity has the potential to safely improve functional ability in severely affected patients with Becker and limb-girdle muscular dystrophies. Copyright © 2014 Elsevier B.V. All rights reserved.

The effect of repeated bouts of backward walking on physiologic efficiency.

PubMed

Childs, John D; Gantt, Christy; Higgins, Dan; Papazis, Janet A; Franklin, Ronald; Metzler, Terri; Underwood, Frank B

2002-08-01

Previous studies have demonstrated an increased energy expenditure with novel tasks. With practice, the energy cost decreases as the body more efficiently recruits motor units. This study examined whether one becomes more efficient after repeated bouts of backward walking. The subjects were 7 healthy subjects between the ages of 23 and 49 years. A backward walking speed was calculated to elicit a VO(2) equal to 60% of the VO(2)max. There were 18 training sessions at the prescribed walking speed 3 d x wk(-1) for 20 min x d(-1). The backward walking speed required to elicit a fixed VO(2) increased between weeks 4 and 6 of the training period. This finding suggests that backward walking is indeed a novel task and that motor learning occurs as a result of practice, leading to a more efficient recruitment of motor units.

Improved postural control after dynamic balance training in older overweight women.

PubMed

Bellafiore, Marianna; Battaglia, Giuseppe; Bianco, Antonino; Paoli, Antonio; Farina, Felicia; Palma, Antonio

2011-01-01

Many studies have reported a greater frequency of falls among older women than men in conditions which stress balance. Previously, we found an improvement in static balance in older women with an increased support surface area and equal load redistribution on both feet, in response to a dynamic balance training protocol. The aim of the present study was to examine whether the same training program and body composition would have effects on the postural control of older overweight women. Ten healthy women (68.67 ± 5.50 yrs; 28.17 ± 3.35 BMI) participated in a five-week physical activity program. This included dynamic balance exercises, such as heel-to-toe walking in different directions, putting their hands on their hips, eyes open (EO) or closed (EC), with a tablet on their heads, going up and down one step, and walking on a mat. Postural stability was assessed before and after training with an optoelectronic platform and a uni-pedal balance performance test. Body composition of the trunk, upper limbs and lower limbs was measured by bio-impedance analysis. The mean speed (MS), medial-lateral MS (MS-x), anterior-posterior MS (MS-y), sway path (SP) and ellipse surface area (ESA) of the pressure center was reduced after training in older women. However, only MS, MS-x, MS-y and SP significantly decreased in bipodalic conditions with EO and MS-y also with EC (p<0.05). Instead, in monopodalic conditions, we found a significant reduction in the ESA of both feet with EO and EC. These data were associated with a significant increase in the lean mass of lower limbs and a higher number of participants who improved their ability to maintain unipedal static balance. Our dynamic balance training protocol appears to be feasible, safe and repeatable for older overweight women and to have positive effects in improving their lateral and anterior-posterior postural control, mainly acting on the visual and skeletal muscle components of the balance control system.

Central adaptations in aerobic circuit versus walking/jogging trained cardiac patients.

PubMed

Goodman, L S; McKenzie, D C; Nath, C R; Schamberger, W; Taunton, J E; Ammann, W C

1995-06-01

This study was done to determine (a) whether in coronary artery disease (CAD) left ventricular (LV) adaptations differed after 6 months of walking/jogging (legs-only, LO) versus aerobic circuit training (arms and legs, AL) versus a control group, and (b) whether a transfer of fitness to the untrained arms in the LO group was related to superior LV adaptations. Peak oxygen uptake for arm and leg ergometry and for cycle ergometry using radionuclide cardiac angiography were performed before and after training. Leg and arm VO2peak increased significantly by 13% in the AL group, and by 13% and 7%, respectively, for the LO group. LV function was greater after training for the LO versus the AL group. Improvements in systolic and diastolic function and a speculated hypervolemia explain these LV adaptations. In CAD patients, walking/jogging produces greater LV function improvements versus circuit training, possibly due to differences in the exercised muscle mass.

Effects of an individualized home-based unsupervised aerobic training on body composition and physiological parameters in obese adults are independent of gender.

PubMed

Emerenziani, G P; Gallotta, M C; Migliaccio, S; Ferrari, D; Greco, E A; Saavedra, F J; Iazzoni, S; Aversa, A; Donini, L M; Lenzi, A; Baldari, C; Guidetti, L

2018-04-01

Evaluation of the effects of an individualized home-based unsupervised aerobic training on body composition, physical and physiological parameters in female and male obese adults. Two hundred and twenty obese adults (age 47.9 ± 12.4 years; BMI 38.0 ± 7.2 kg/m 2 ) entered the 4-month training program. Body composition, physiological and functional capacities were assessed pre- and post-intervention. All subjects were requested to perform unsupervised aerobic training with the intensity based on heart rate, walking speed and OMNI-RPE score corresponding to the individual ventilatory threshold for at least 5 days/week. After 4-month study period, 40% of patients completed the protocol, 24% had high compliance (HC) (exercise ≥ 3 days/week), while 16% had low compliance (LC) to exercise prescription (exercise < than 3 days/week). In HC group, a significant improvement of body composition variables after training was performed. Moreover, oxygen uptake and metabolic equivalent at peak significantly increased after training. Six-minute walking test (6MWT) distance significantly increased while heart rate during 6MWT was significantly lower after training. No significant differences were found in LC group between pre- and post-intervention in all variables. Interestingly, gender does not influence the effects of training. Our results indicate that subjects, independent of gender, with high compliance to the aerobic training based on a new individualized method can achieve a significant reduction in weight loss and also an improvement in physical and physiological parameters. This innovative personalized prescription could be a valuable tool for exercise physiologist, endocrinologists, and nutritionists to approach and correct life style of obese subjects.

RCT of a 6-month programmed sports therapy (PST) in patients with haemophilia - Improvement of physical fitness.

PubMed

Runkel, B; Czepa, D; Hilberg, T

2016-09-01

Physical fitness is of major importance for patients with haemophilia (PwH) but is highly influenced by bleeding episodes. Although some cohort studies describe an improvement of physical fitness after training intervention, randomized controlled studies (RCT) in PwH are still rare. The aim of this study was to prove the enhancement of physical work capacity in PwH by programmed sports therapy (PST). This RCT includes a training period over six months. Sixty-four PwH with moderate (n = 5) to severe (n = 59) haemophilia A (n = 57) and B (n = 7) were randomized into two groups - training intervention group (IG) and control group (CG) by block randomization. Complex strength measurements, joint score, coordination check and a 12-min walking test were carried out before and after training intervention. Significant differences were tested in M. triceps brachii (Δ+0.62 N kg(-1) ), biceps brachii (Δ+1.25 N kg(-1) ), latissimus dorsi (Δ+0.59 N kg(-1) ), rectus abdominis (Δ+0.51 N kg(-1) ), biceps femoris (right: Δ+0.68 N kg(-1) ; left: Δ+0.59 N kg(-1) ) and the quadriceps femoris (right: Δ+0.71 N kg(-1) ; left: Δ+0.55 N kg(-1) ) after intervention between the two groups (all p ≤ 0.003). Furthermore, an increase in distance (Δ+171.5 m) covered in the 12-min walking test (P = 0.011) was observed. Regarding one-leg stand, a significant improvement (P = 0.037) in the IG (Δ+2.2 s right leg) after intervention could be determined. For the first time, a study with a corresponding number of adult PwH in a RCT-design showed that programmed sport therapy with specific instructions over 6 months has a positive effect on physical performance of PwH, independent of constitution and disease process. © 2016 John Wiley & Sons Ltd.

Ankle Training With a Robotic Device Improves Hemiparetic Gait After a Stroke

PubMed Central

Forrester, Larry W.; Roy, Anindo; Krebs, Hermano Igo; Macko, Richard F.

2013-01-01

Background Task-oriented therapies such as treadmill exercise can improve gait velocity after stroke, but slow velocities and abnormal gait patterns often persist, suggesting a need for additional strategies to improve walking. Objectives To determine the effects of a 6-week visually guided, impedance controlled, ankle robotics intervention on paretic ankle motor control and gait function in chronic stroke. Methods This was a single-arm pilot study with a convenience sample of 8 stroke survivors with chronic hemiparetic gait, trained and tested in a laboratory. Subjects trained in dorsiflexion–plantarflexion by playing video games with the robot during three 1-hour training sessions weekly, totaling 560 repetitions per session. Assessments included paretic ankle ranges of motion, strength, motor control, and overground gait function. Results Improved paretic ankle motor control was seen as increased target success, along with faster and smoother movements. Walking velocity also increased significantly, whereas durations of paretic single support increased and double support decreased. Conclusions Robotic feedback training improved paretic ankle motor control with improvements in floor walking. Increased walking speeds were comparable with reports from other task-oriented, locomotor training approaches used in stroke, suggesting that a focus on ankle motor control may provide a valuable adjunct to locomotor therapies. PMID:21115945

"You gotta try it all": Parents' Experiences with Robotic Gait Training for their Children with Cerebral Palsy.

PubMed

Beveridge, Briony; Feltracco, Deanna; Struyf, Jillian; Strauss, Emily; Dang, Saniya; Phelan, Shanon; Wright, F Virginia; Gibson, Barbara E

2015-01-01

Innovative robotic technologies hold strong promise for improving walking abilities of children with cerebral palsy (CP), but may create expectations for parents pursuing the "newest thing" in treatment. The aim of this qualitative study was to explore parents' values about walking in relation to their experiences with robotic gait training for their children. Semi-structured interviews were conducted with parents of five ambulatory children with CP participating in a randomized trial investigating robotic gait training effectiveness. Parents valued walking, especially "correct" walking, as a key component of their children's present and future well-being. They continually sought the "next best thing" in therapy and viewed the robotic gait trainer as a potentially revolutionary technology despite mixed experiences. The results can help inform rehabilitation therapists' knowledge of parents' values and perspectives, and guide effective collaborations toward meeting the therapeutic needs of children with CP.

Visual and kinesthetic locomotor imagery training integrated with auditory step rhythm for walking performance of patients with chronic stroke.

PubMed

Kim, Jin-Seop; Oh, Duck-Won; Kim, Suhn-Yeop; Choi, Jong-Duk

2011-02-01

To compare the effect of visual and kinesthetic locomotor imagery training on walking performance and to determine the clinical feasibility of incorporating auditory step rhythm into the training. Randomized crossover trial. Laboratory of a Department of Physical Therapy. Fifteen subjects with post-stroke hemiparesis. Four locomotor imagery trainings on walking performance: visual locomotor imagery training, kinesthetic locomotor imagery training, visual locomotor imagery training with auditory step rhythm and kinesthetic locomotor imagery training with auditory step rhythm. The timed up-and-go test and electromyographic and kinematic analyses of the affected lower limb during one gait cycle. After the interventions, significant differences were found in the timed up-and-go test results between the visual locomotor imagery training (25.69 ± 16.16 to 23.97 ± 14.30) and the kinesthetic locomotor imagery training with auditory step rhythm (22.68 ± 12.35 to 15.77 ± 8.58) (P < 0.05). During the swing and stance phases, the kinesthetic locomotor imagery training exhibited significantly increased activation in a greater number of muscles and increased angular displacement of the knee and ankle joints compared with the visual locomotor imagery training, and these effects were more prominent when auditory step rhythm was integrated into each form of locomotor imagery training. The activation of the hamstring during the swing phase and the gastrocnemius during the stance phase, as well as kinematic data of the knee joint, were significantly different for posttest values between the visual locomotor imagery training and the kinesthetic locomotor imagery training with auditory step rhythm (P < 0.05). The therapeutic effect may be further enhanced in the kinesthetic locomotor imagery training than in the visual locomotor imagery training. The auditory step rhythm together with the locomotor imagery training produces a greater positive effect in improving the walking performance of patients with post-stroke hemiparesis.

Cognitive and motor dual task gait training improve dual task gait performance after stroke - A randomized controlled pilot trial.

PubMed

Liu, Yan-Ci; Yang, Yea-Ru; Tsai, Yun-An; Wang, Ray-Yau

2017-06-22

This study investigated effects of cognitive and motor dual task gait training on dual task gait performance in stroke. Participants (n = 28) were randomly assigned to cognitive dual task gait training (CDTT), motor dual task gait training (MDTT), or conventional physical therapy (CPT) group. Participants in CDTT or MDTT group practiced the cognitive or motor tasks respectively during walking. Participants in CPT group received strengthening, balance, and gait training. The intervention was 30 min/session, 3 sessions/week for 4 weeks. Three test conditions to evaluate the training effects were single walking, walking while performing cognitive task (serial subtraction), and walking while performing motor task (tray-carrying). Parameters included gait speed, dual task cost of gait speed (DTC-speed), cadence, stride time, and stride length. After CDTT, cognitive-motor dual task gait performance (stride length and DTC-speed) was improved (p = 0.021; p = 0.015). After MDTT, motor dual task gait performance (gait speed, stride length, and DTC-speed) was improved (p = 0.008; p = 0.008; p = 0.008 respectively). It seems that CDTT improved cognitive dual task gait performance and MDTT improved motor dual task gait performance although such improvements did not reach significant group difference. Therefore, different types of dual task gait training can be adopted to enhance different dual task gait performance in stroke.

Formative process evaluation for implementing a social marketing intervention to increase walking among African Americans in the Positive Action for Today's Health trial.

PubMed

Coulon, Sandra M; Wilson, Dawn K; Griffin, Sarah; St George, Sara M; Alia, Kassandra A; Trumpeter, Nevelyn N; Wandersman, Abraham K; Forthofer, Melinda; Robinson, Shamika; Gadson, Barney

2012-12-01

Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today's Health trial. We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months. Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating. Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.

Dynamic balance and stepping versus tai chi training to improve balance and stepping in at-risk older adults.

PubMed

Nnodim, Joseph O; Strasburg, Debra; Nabozny, Martina; Nyquist, Linda; Galecki, Andrzej; Chen, Shu; Alexander, Neil B

2006-12-01

To compare the effect of two 10-week balance training programs, Combined Balance and Step Training (CBST) versus tai chi (TC), on balance and stepping measures. Prospective intervention trial. Local senior centers and congregate housing facilities. Aged 65 and older with at least mild impairment in the ability to perform unipedal stance and tandem walk. Participants were allocated to TC (n = 107, mean age 78) or CBST, an intervention focused on improving dynamic balance and stepping (n = 106, mean age 78). At baseline and 10 weeks, participants were tested in their static balance (Unipedal Stance and Tandem Stance (TS)), stepping (Maximum Step Length, Rapid Step Test), and Timed Up and Go (TUG). Performance improved more with CBST than TC, ranging from 5% to 10% for the stepping tests (Maximum Step Length and Rapid Step Test) and 9% for TUG. The improvement in TUG represented an improvement of more than 1 second. Greater improvements were also seen in static balance ability (in TS) with CBST than TC. Of the two training programs, in which variants of each program have been proven to reduce falls, CBST results in modest improvements in balance, stepping, and functional mobility versus TC over a 10-week period. Future research should include a prospective comparison of fall rates in response to these two balance training programs.

Overground body-weight-supported gait training for children and youth with neuromuscular impairments.

PubMed

Kurz, Max J; Stuberg, Wayne; Dejong, Stacey; Arpin, David J

2013-08-01

The aim of this investigation was to determine if body-weight-supported (BWS) overground gait training has the potential to improve the walking abilities of children and youth with childhood onset motor impairments and intellectual disabilities. Eight participants (mean age of 16.3 years) completed 12 weeks of BWS overground gait training that was performed two times a week. BWS was provided during the training sessions by an overhead harness system that rolls overground. There was a significant improvement in the preferred walking speed after the training (p < .01; pre = 0.51 ± 0.2 m/s; post = 0.67 ± 0.3 m/s; Cohen's d = 0.80) and cadence (p = .04; pre = 37 ± 7 steps/min; post = 43 ± 8 steps/min; Cohen's d = 0.94). Our results indicate that overground BWS gait training may be an effective treatment strategy for improving the preferred walking speed of children and youth with motor impairments.

Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: a preliminary prospective longitudinal study.

PubMed

Paker, Nurdan; Bugdayci, Derya; Goksenoglu, Goksen; Sen, Aysu; Kesiktas, Nur

2013-01-01

Decreased mobility and walking capacity occur frequently in Parkinson's disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation. The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD. Seventy patients with idiopathic Parkinson's disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinson's Disease Rating Scale (UPDRS) motor section and Parkinson's Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study. Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1-3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control. As a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment.

The voluntary driven exoskeleton Hybrid Assistive Limb (HAL) for postoperative training of thoracic ossification of the posterior longitudinal ligament: a case report.

PubMed

Fujii, Kengo; Abe, Tetsuya; Kubota, Shigeki; Marushima, Aiki; Kawamoto, Hiroaki; Ueno, Tomoyuki; Matsushita, Akira; Nakai, Kei; Saotome, Kosaku; Kadone, Hideki; Endo, Ayumu; Haginoya, Ayumu; Hada, Yasushi; Matsumura, Akira; Sankai, Yoshiyuki; Yamazaki, Masashi

2017-05-01

The hybrid assistive limb (HAL) is a wearable robot suit that assists in voluntary control of knee and hip joint motion by detecting bioelectric signals on the surface of the skin with high sensitivity. HAL has been reported to be effective for functional recovery in motor impairments. However, few reports have revealed the utility of HAL for patients who have undergone surgery for thoracic ossification of the posterior longitudinal ligament (thoracic OPLL). Herein, we present a postoperative thoracic OPLL patient who showed remarkable functional recovery after training with HAL. A 63-year-old woman, who could not walk due to muscle weakness before surgery, underwent posterior decompression and fusion. Paralysis was re-aggravated after the initial postoperative rising. We diagnosed that paralysis was due to residual compression from the anterior lesion and microinstability after posterior fixation, and prescribed bed rest for a further 3 weeks. The incomplete paralysis gradually recovered, and walking training with HAL was started on postoperative day 44 in addition to standard physical therapy. The patient underwent 10 sessions of HAL training until discharge on postoperative day 73. Results of a 10-m walk test were assessed after every session, and the patient's speed and cadence markedly improved. At discharge, the patient could walk with 2 crutches and no assistance. Furthermore, no adverse events associated with HAL training occurred. HAL training for postoperative thoracic OPLL patients may enhance improvement in walking ability, even if severe impairment of ambulation and muscle weakness exist preoperatively.

The voluntary driven exoskeleton Hybrid Assistive Limb (HAL) for postoperative training of thoracic ossification of the posterior longitudinal ligament: a case report

PubMed Central

Abe, Tetsuya; Kubota, Shigeki; Marushima, Aiki; Kawamoto, Hiroaki; Ueno, Tomoyuki; Matsushita, Akira; Nakai, Kei; Saotome, Kosaku; Kadone, Hideki; Endo, Ayumu; Haginoya, Ayumu; Hada, Yasushi; Matsumura, Akira; Sankai, Yoshiyuki; Yamazaki, Masashi

2017-01-01

Context The hybrid assistive limb (HAL) is a wearable robot suit that assists in voluntary control of knee and hip joint motion by detecting bioelectric signals on the surface of the skin with high sensitivity. HAL has been reported to be effective for functional recovery in motor impairments. However, few reports have revealed the utility of HAL for patients who have undergone surgery for thoracic ossification of the posterior longitudinal ligament (thoracic OPLL). Herein, we present a postoperative thoracic OPLL patient who showed remarkable functional recovery after training with HAL. Findings A 63-year-old woman, who could not walk due to muscle weakness before surgery, underwent posterior decompression and fusion. Paralysis was re-aggravated after the initial postoperative rising. We diagnosed that paralysis was due to residual compression from the anterior lesion and microinstability after posterior fixation, and prescribed bed rest for a further 3 weeks. The incomplete paralysis gradually recovered, and walking training with HAL was started on postoperative day 44 in addition to standard physical therapy. The patient underwent 10 sessions of HAL training until discharge on postoperative day 73. Results of a 10-m walk test were assessed after every session, and the patient's speed and cadence markedly improved. At discharge, the patient could walk with 2 crutches and no assistance. Furthermore, no adverse events associated with HAL training occurred. Conclusion HAL training for postoperative thoracic OPLL patients may enhance improvement in walking ability, even if severe impairment of ambulation and muscle weakness exist preoperatively. PMID:26856189

The GRONORUN 2 study: effectiveness of a preconditioning program on preventing running related injuries in novice runners. The design of a randomized controlled trial.

PubMed

Bredeweg, Steef W; Zijlstra, Sjouke; Buist, Ida

2010-09-01

Distance running is a popular recreational exercise. It is a beneficial activity for health and well being. However, running may also cause injuries, especially of the lower extremities. In literature there is no agreement what intrinsic and extrinsic factors cause running related injuries (RRIs). In theory, most RRIs are elicited by training errors, this too much, too soon. In a preconditioning program runners can adapt more gradually to the high mechanical loads of running and will be less susceptible to RRIs. In this study the effectiveness of a 4-week preconditioning program on the incidence of RRIs in novice runners prior to a training program will be studied. The GRONORUN 2 (Groningen Novice Running) study is a two arm randomized controlled trial studying the effect of a 4-week preconditioning (PRECON) program in a group of novice runners. All participants wanted to train for the recreational Groningen 4-Mile running event. The PRECON group started a 4-week preconditioning program with walking and hopping exercises 4 weeks before the start of the training program. The control (CON) and PRECON group started a frequently used 9-week training program in preparation for the Groningen 4-Mile running event.During the follow up period participants registered their running exposure, other sporting activities and running related injuries in an Internet based running log. The primary outcome measure was the number of RRIs. RRI was defined as a musculoskeletal ailment or complaint of the lower extremities or back causing a restriction on running for at least three training sessions. The GRONORUN 2 study will add important information to the existing running science. The concept of preconditioning is easy to implement in existing training programs and will hopefully prevent RRIs especially in novice runners. The Netherlands National Trial Register NTR1906. The NTR is part of the WHO Primary Registries.

EFFECTS OF STRENGTH TRAINING ON PHYSICAL FUNCTION: INFLUENCE OF POWER, STRENGTH, AND BODY COMPOSITION

PubMed Central

Hanson, Erik D.; Srivatsan, Sindhu R.; Agrawal, Siddhartha; Menon, Kalapurakkal S.; Delmonico, Matthew J.; Wang, Min Q.; Hurley, Ben F.

2010-01-01

The purpose of this study was to determine (a) the effects of strength training (ST) on physical function and (b) the influence of strength, power, muscle volume (MV), and body composition on physical function. Healthy, inactive adults (n = 50) aged 65 years and older underwent strength, power, total body composition (% fat and fat free mass [FFM]), and physical function testing before and after 22 weeks of ST. Physical function testing consisted of tasks designed to mimic common physical activities of daily living (ADL). To improve internal validity of the assessment of mid-thigh intermuscular fat, subcutaneous fat, and knee extensors MV, a 10-week unilateral ST program using the untrained leg as an internal control preceded 12 weeks of whole-body ST. Strength, power, and FFM increased significantly with ST (all p < 0.05), whereas rapid walk, 5 chair stands, and get up and go time decreased significantly with ST in the overall group (all p < 0.05). Women improved significantly in both walking test times (both p < 0.05) but not in the stair climb test, whereas men improved in the stair climb test (p < 0.05) but not in walking test times. Multiple regression analysis revealed the highest R2 (0.28) for the change in chair stands time, followed by stair climb and usual walk at 0.27 and 0.21, respectively. ST improves performance in functional tasks important for ADLs. Changes in strength, power, and FFM are predictors of ST-induced improvements in these tasks. PMID:19910811

Underwater gait analysis in Parkinson's disease.

PubMed

Volpe, Daniele; Pavan, Davide; Morris, Meg; Guiotto, Annamaria; Iansek, Robert; Fortuna, Sofia; Frazzitta, Giuseppe; Sawacha, Zimi

2017-02-01

Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Unstable footwear as a speed-dependent noise-based training gear to exercise inverted pendulum motion during walking.

PubMed

Dierick, Frédéric; Bouché, Anne-France; Scohier, Mikaël; Guille, Clément; Buisseret, Fabien

2018-05-15

Previous research on unstable footwear has suggested that it may induce mechanical noise during walking. The purpose of this study was to explore whether unstable footwear could be considered as a noise-based training gear to exercise body center of mass (CoM) motion during walking. Ground reaction forces were collected among 24 healthy young women walking at speeds between 3 and 6 km h -1 with control running shoes and unstable rocker-bottom shoes. The external mechanical work, the recovery of mechanical energy of the CoM during and within the step cycles, and the phase shift between potential and kinetic energy curves of the CoM were computed. Our findings support the idea that unstable rocker-bottom footwear could serve as a speed-dependent noise-based training gear to exercise CoM motion during walking. At slow speed, it acts as a stochastic resonance or facilitator that reduces external mechanical work; whereas at brisk speed it acts as a constraint that increases external mechanical work and could mimic a downhill slope.

A dual-learning paradigm can simultaneously train multiple characteristics of walking

PubMed Central

Toliver, Alexis; Bastian, Amy J.

2016-01-01

Impairments in human motor patterns are complex: what is often observed as a single global deficit (e.g., limping when walking) is actually the sum of several distinct abnormalities. Motor adaptation can be useful to teach patients more normal motor patterns, yet conventional training paradigms focus on individual features of a movement, leaving others unaddressed. It is known that under certain conditions, distinct movement components can be simultaneously adapted without interference. These previous “dual-learning” studies focused solely on short, planar reaching movements, yet it is unknown whether these findings can generalize to a more complex behavior like walking. Here we asked whether a dual-learning paradigm, incorporating two distinct motor adaptation tasks, can be used to simultaneously train multiple components of the walking pattern. We developed a joint-angle learning task that provided biased visual feedback of sagittal joint angles to increase peak knee or hip flexion during the swing phase of walking. Healthy, young participants performed this task independently or concurrently with another locomotor adaptation task, split-belt treadmill adaptation, where subjects adapted their step length symmetry. We found that participants were able to successfully adapt both components of the walking pattern simultaneously, without interference, and at the same rate as adapting either component independently. This leads us to the interesting possibility that combining rehabilitation modalities within a single training session could be used to help alleviate multiple deficits at once in patients with complex gait impairments. PMID:26961100

Technology-Based Programs to Promote Walking Fluency or Improve Foot-Ground Contact during Walking: Two Case Studies of Adults with Multiple Disabilities

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; La Martire, Maria L.; Oliva, Doretta; Groeneweg, Jop

2012-01-01

These two case studies assessed technology-based programs for promoting walking fluency and improving foot-ground contact during walking with a man and a woman with multiple disabilities, respectively. The man showed breaks during walking and the woman presented with toe walking. The technology used in the studies included a microprocessor with…

Using short vignettes to disentangle perceived capability from motivation: a test using walking and resistance training behaviors.

PubMed

Rhodes, Ryan E; Williams, David M; Mistry, Chetan D

2016-07-01

Self-efficacy is arguably the strongest correlate of physical activity, yet some researchers suggest this is because the construct confounds ability with motivation. We examine a more circumscribed construct, called perceived capability (PC), meant to measure ability but not motivation and propose that the construct will not be related to unskilled physical activities but may be linked to skilled behaviors. The purpose of this paper was to examine whether a PC construct can be stripped of motivation using a vignette approach in both walking and resistance training behaviors. Participants were a random sample of 248 university students, who were then randomly assigned to either answer resistance training or walking behavior questions. Both groups completed a PC measure and reasons for their answer before and after reading a vignette that clarified the phrasing of capability to a literal use of the term. PC was significantly (p < .01) higher post- compared to pre-vignette and the differences were greater (p < .01) for walking than for resistance training. PC had significantly (p < .01) smaller correlations with intention and self-reported behavior post-disambiguation, which resulted in a null relationship with walking but a small correlation with resistance training behavior. When PC was combined with intention to predict behavior, however, there was no significant (p > .05) difference in the amount of variance explained pre- to post-vignette. Thought listing showed that participants did not report capability barriers to walking and over half of the sample construed capability as motivation/other priorities pre-vignette. The findings support use of a vignette approach for researchers who wish to disentangle the assessment of PC from motivation while creating no overall loss in explained variance of physical activity.

A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury.

PubMed

Street, Tamsyn; Singleton, Christine

2018-05-01

The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). A specialist FES outpatient centre. Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.

Effects of an individual 12-week community-located "start-to-run" program on physical capacity, walking, fatigue, cognitive function, brain volumes, and structures in persons with multiple sclerosis.

PubMed

Feys, Peter; Moumdjian, Lousin; Van Halewyck, Florian; Wens, Inez; Eijnde, Bert O; Van Wijmeersch, Bart; Popescu, Veronica; Van Asch, Paul

2017-11-01

Exercise therapy studies in persons with multiple sclerosis (pwMS) primarily focused on motor outcomes in mid disease stage, while cognitive function and neural correlates were only limitedly addressed. This pragmatic randomized controlled study investigated the effects of a remotely supervised community-located "start-to-run" program on physical and cognitive function, fatigue, quality of life, brain volume, and connectivity. In all, 42 pwMS were randomized to either experimental (EXP) or waiting list control (WLC) group. The EXP group received individualized training instructions during 12 weeks (3×/week), to be performed in their community aiming to participate in a running event. Measures were physical (VO 2max , sit-to-stand test, Six-Minute Walk Test (6MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12)) and cognitive function (Rao's Brief Repeatable Battery (BRB), Paced Auditory Serial Attention Test (PASAT)), fatigue (Fatigue Scale for Motor and Cognitive Function (FSMC)), quality of life (Multiple Sclerosis Impact Scale-29 (MSIS-29)), and imaging. Brain volumes and diffusion tensor imaging (DTI) were quantified using FSL-SIENA/FIRST and FSL-TBSS. In all, 35 pwMS completed the trial. Interaction effects in favor of the EXP group were found for VO 2max , sit-to-stand test, MSWS-12, Spatial Recall Test, FSMC, MSIS-29, and pallidum volume. VO 2max improved by 1.5 mL/kg/min, MSWS-12 by 4, FSMC by 11, and MSIS-29 by 14 points. The Spatial Recall Test improved by more than 10%. Community-located run training improved aerobic capacity, functional mobility, visuospatial memory, fatigue, and quality of life and pallidum volume in pwMS.

Improved parent-reported mobility and achievement of individual goals on activity and participation level after functional power-training in young children with cerebral palsy: a double-baseline controlled trial.

PubMed

van Vulpen, Liesbeth F; de Groot, Sonja; Rameckers, Eugene A; Becher, Jules G; Dallmeijer, Annet J

2018-03-07

In children with cerebral palsy (CP), strength training programs to improve walking capacity and participation in activities of daily living are commonly used in clinical practice, despite lacking evidence of its effectiveness. It has been suggested that strength training with high movement velocity could be more effective than traditional resistance training to improve functional abilities such as walking. In a recently published study, we have demonstrated the positive effects of functional high-velocity resistance (power) training on muscle strength and walking capacity in young children with CP. Whether this type of training is also effective in achieving individual predefined goals in daily activities and self-reported mobility limitations, has not yet been described however. To evaluate the effect of functional power-training on parent-reported mobility and achievement of individual goals on activity and participation level in young children with CP. A double-baseline design was used to compare a 14-week period usual care with a 14-week period of functional power-training (3 times a week) and a follow-up period of 14-weeks. Twenty-two children with spastic CP (13 bilateral, GMFCS level I (N=10) and level II (N=12), mean age 7.5 years (SD 1.8, range 4-10 y)) and their parents participated. Outcome measures were goal attainment scaling (GAS) of individual daily activity related treatment goals, mobility performance as measured using the Functional Mobility Scale (FMS-5m, 50m and 500m), and the parent-reported Mobility Questionnaire (MobQues). After power-training, 86% of children achieved or exceeded their goal, compared with 14% in the usual care period (p<.001). The probability of improvement by one point or more on the FMS- 500 meter after functional power-training was 10 times higher, compared with the usual care period (Relative Risk=10.0 with 95%CI 1.4 - 71.3). No changes were found in the FMS-5m and FMS-50m categories. Improvement on the MobQues was significantly greater after power-training compared with usual care (7.9% (95% CI 2.7 - 13.0, p=.005)). The improvement in performance in the activities defined in the treatment goals continued during the follow-up period. The results indicated that functional power- training is an effective training to achieve personalized treatment goals for activities in daily life and parent-reported mobility performance in young children with cerebral palsy.

Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study

PubMed Central

Schättin, Alexandra; Arner, Rendel; Gennaro, Federico; de Bruin, Eling D.

2016-01-01

During aging, the prefrontal cortex (PFC) undergoes age-dependent neuronal changes influencing cognitive and motor functions. Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults. Especially, video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults. The aim of this study was to compare conventional balance training with video game-based physical exercise, a so-called exergame, on the relative power (RP) of electroencephalographic (EEG) frequencies over the PFC, executive function (EF), and gait performance. Twenty-seven participants (mean age 79.2 ± 7.3 years) were randomly assigned to one of two groups. All participants completed 24 trainings including three times a 30 min session/week. The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [L(14) = 6.23, p = 0.007]. Comparing pre- vs. post-test, EFs improved both within the exergame (working memory: z = −2.28, p = 0.021; divided attention auditory: z = −2.51, p = 0.009; divided attention visual: z = −2.06, p = 0.040; go/no-go: z = −2.55, p = 0.008; set-shifting: z = −2.90, p = 0.002) and within the balance group (set-shifting: z = −2.04, p = 0.042). Moreover, spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions (speed normal walking: z = −2.90, p = 0.002; speed fast walking: z = −2.97, p = 0.001; cadence normal walking: z = −2.97, p = 0.001; stride length fast walking: z = −2.69, p = 0.005) and within the balance group under single-task conditions (speed normal walking: z = −2.54, p = 0.009; speed fast walking: z = −1.98, p = 0.049; cadence normal walking: z = −2.79, p = 0.003). These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and/or function in varying proportion. PMID:27932975

Changes in Gait Symmetry After Training on a Treadmill with Biofeedback in Chronic Stroke Patients: A 6-Month Follow-Up from a Randomized Controlled Trial

PubMed Central

Drużbicki, Mariusz; Guzik, Agnieszka; Przysada, Grzegorz; Kwolek, Andrzej; Brzozowska-Magoń, Agnieszka; Sobolewski, Marek

2016-01-01

Background One of the most significant challenges for patients who survive a stroke is relearning basic motor tasks such as walking. The goal of this study was to evaluate whether training on a treadmill with visual biofeedback improves gait symmetry, as well as spatiotemporal and kinematic gait parameters, in stroke patients. Material/Methods Thirty patients in the chronic phase after a stroke were randomly allocated into groups with a rehabilitation program of treadmill training with or without visual biofeedback. The training program lasted 10 days. Spatiotemporal and kinematic gait parameters were evaluated. For all parameters analyzed, a symmetrical index was calculated. Follow-up studies were performed 6 months after completion of the program. Results The symmetrical index had significantly normalized in terms of the step length (p=0.006), stance phase time, and inter-limb ratio in the intervention group. After 6 months, the improvement in the symmetry of the step length had been maintained. In the control group, no statistically significant change was observed in any of the parameters tested. There was no significant difference between the intervention group and the control group on completion of the program or at 6 months following the completion of the program. Conclusions Training on a treadmill has a significant effect on the improvement of spatiotemporal parameters and symmetry of gait in patients with chronic stroke. In the group with the treadmill training using visual biofeedback, no significantly greater improvement was observed. PMID:27941712

Astronaut Linda Godwin during contingency EVA training in WETF

NASA Image and Video Library

1993-08-17

S93-41572 (17 Aug 1993) --- Astronaut Linda M. Godwin, payload commander, prepares to donn her helmet before being submerged in a 25-feet deep pool at the Johnson Space Center's (JSC) Weightless Environment Training Facility (WET-F). Astronauts Godwin and Thomas D. Jones, mission specialist, are using the WET-F to train for contingency space walks for their Space Shuttle Endeavour mission next year. No space walks are planned for the flight.

Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint.

PubMed

Cadore, Eduardo L; Moneo, Ana B Bays; Mensat, Marta Martinez; Muñoz, Andrea Rozas; Casas-Herrero, Alvaro; Rodriguez-Mañas, Leocadio; Izquierdo, Mikel

2014-04-01

This study investigated the effects of a multicomponent exercise intervention on muscle strength, incidence of falls and functional outcomes in frail elderly patients with dementia after long-term physical restraint, followed by 24 weeks of training cessation. Eighteen frail elderly patients with mild dementia (88.1 ± 5.1 years) performed a multicomponent exercise program, which consisted of 4 weeks of walking, balance and cognitive exercises, followed by 4 weeks of resistance exercise performed twice weekly [8-12 repetitions at 20-50 % of the one-repetition maximum (1RM)], combined with walking, balance and cognitive exercises. Before and after training, as well as after 24 weeks of training cessation, strength outcomes, Barthel Index, balance, gait ability, rise from a chair ability, dual task performance, incidence of falls and Mini-Mental State Examination were assessed. After the first 4 weeks of training, there was a significant improvement only in the balance test, whereas no additional changes were observed. However, after the second part of the training, the participants required significantly less time for the time-up-and-go test (P < 0.05), and improved the isometric hand grip, hip flexion and knee extension strength, as well as the leg press 1RM (P < 0.01). A significant reduction was also observed in the incidence of falls (P < 0.01). After 24 weeks of training cessation, abrupt decreases were observed in nearly all of the physical outcomes (P < 0.05). The exercise intervention improved strength, balance and gait ability in frail elderly patients with dementia after long-term physical restraint, and these benefits were lost after training cessation.

Intensive aerobic cycling training with lower limb weights in Chinese patients with chronic stroke: discordance between improved cardiovascular fitness and walking ability.

PubMed

Jin, Hong; Jiang, Yibo; Wei, Qin; Wang, Bilei; Ma, Genshan

2012-01-01

To evaluate the effect of aerobic cycling training with lower limb weights on cardiovascular fitness (peak VO(2)) and walking ability in chronic stroke survivors, and to investigate the relationship between changes in these parameters. 133 Chinese patients with chronic hemiparetic stroke (mean age 58 years) were randomized to either 8-week (5×/week) aerobic cycling training with lower limb weights group (n = 68) or a low-intensity overground walking group (n = 65). Peak VO(2), 6-minute walk distance (6MWD), knee muscle strength, balance and spasticity were measured before and after intervention. Cycling training increased peak VO(2) (24% vs. 3%, p < 0.001), 6MWD (2.7% vs. 0.5%, p < 0.001), paretic (11% vs. 1.6%, p < 0.001) and nonparetic knee strength (16% vs. 1.0%, p < 0.001). In the cycling group, percent changes in peak VO(2) were positively associated with those in paretic (r = 0.491, p < 0.001) and nonparetic knee strength (r = 0.432, p < 0.001). Increased 6MWD correlated significantly with improved balance, spasticity and paretic knee strength by the stepwise regression analysis (r(2) = 0.342, p = 0.004), but not fitness gains. The enhanced cardiovascular fitness after aerobic cycling training in Chinese patients with chronic stroke is not associated with the increased walking ability. Unparallel improvements in these parameters related different determinants may have implications for intervention strategy.

The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial.

PubMed

Ferraz, Daniel Dominguez; Trippo, Karen Valadares; Duarte, Gabriel Pereira; Neto, Mansueto Gomes; Bernardes Santos, Kionna Oliveira; Filho, Jamary Oliveira

2018-05-01

To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD). A pilot randomized, controlled, single-blinded trial. A state reference health care center for elderly, a public reference outpatient clinic for the elderly. Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank. The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20). The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale. All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups. Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

[The influence of locomotor treatment using robotic body-weight-supported treadmill training on rehabilitation outcome of patients suffering from neurological disorders].

PubMed

Schwartz, Isabella; Meiner, Zeev

2013-03-01

Regaining one's ability to walk is of great importance for neurological patients and is a major goal of all rehabilitation programs. Treating neurological patients in the acute phase after the event is technically difficult because of their motor weakness and balance disturbances. Based on studies in spinalized animals, a novel locomotor training that incorporates high repetitions of task-oriented practice by the use of body weight-supported treadmill training (BWSTT) was developed to overcome these obstacles. The use of BWSTT enables early initiation of gait training, integration of weightbearing activities, stepping and balance by the use of a task-specific approach, and a symmetrical gait pattern. However, despite the theoretical potential of BWSTT to become an invaluable therapeutic tool, its effect on walking outcomes was disappointing when compared with conventional training of the same duration. To facilitate the deLivery of BWSTT, a motorized robotic driven gait orthosis (RBWSTT) was recently developed. It has many advantages over the conventional method, including less effort for the physiotherapists, longer session duration, more physiological and reproducible gait patterns, and the possibility of measuring a patient's performances. Several studies have been conducted using RBWSTT in patients after stroke, spinal cord injury, multiple sclerosis and other neurological diseases. Although some of the results were encouraging, there is still uncertainty regarding proper patient selection, timing and protocol for RBWTT treatment following neurological diseases. More large randomized controlled studies are needed in order to answer these questions.

Five clinical tests to assess balance following ball exercises and treadmill training in adult persons with intellectual disability.

PubMed

Carmeli, Eli; Bar-Chad, Shmuel; Lotan, Meir; Merrick, Joav; Coleman, Raymond

2003-08-01

Incidence rates of falling increase progressively with aging. Preventing or delaying the onset of functional decline is a crucial important goal, because more individuals with intellectual disability (ID) are living well into their sixth and seventh decades. The question of whether walking and ball exercises can effect balance performance has never been reported. This pilot study was conducted to determine the effects of therapeutic training on improving balance capabilities in adults with mild ID. The study included 13 women and 4 men, aged 50-67 years (mean age 56.5 years) residing in a residential care center. Five clinical tests were used to determine the "real" picture of the locomotor function and balance before and after the training protocol. Baseline values were determined using 2 control groups of age-matched adults with and without ID. The tests included modified get-up-and-go, full turn, forward reach, sit-to-stand, and one-legged standing. Therapeutic training for 6 months included dynamic ball exercises and treadmill walking with a 2-3% positive inclination. Participants in the program showed little to no improvement in terms of their static and dynamic balance compared to their initial values. Thus, only 2 of the tests showed statistical significance. Lack of improvement was noted in both postural and balance control in adults with mild ID as a result of 6 months of intervention by means of ball exercise and treadmill training.

Effects of a 6-month exercise program pilot study on walking economy, peak physiological characteristics, and walking performance in patients with peripheral arterial disease.

PubMed

Crowther, Robert G; Leicht, Anthony S; Spinks, Warwick L; Sangla, Kunwarjit; Quigley, Frank; Golledge, Jonathan

2012-01-01

The purpose of this study was to examine the effects of a 6-month exercise program on submaximal walking economy in individuals with peripheral arterial disease and intermittent claudication (PAD-IC). Participants (n = 16) were randomly allocated to either a control PAD-IC group (CPAD-IC, n = 6) which received standard medical therapy, or a treatment PAD-IC group (TPAD-IC; n = 10) which took part in a supervised exercise program. During a graded treadmill test, physiological responses, including oxygen consumption, were assessed to calculate walking economy during submaximal and maximal walking performance. Differences between groups at baseline and post-intervention were analyzed via Kruskal-Wallis tests. At baseline, CPAD-IC and TPAD-IC groups demonstrated similar walking performance and physiological responses. Postintervention, TPAD-IC patients demonstrated significantly lower oxygen consumption during the graded exercise test, and greater maximal walking performance compared to CPAD-IC. These preliminary results indicate that 6 months of regular exercise improves both submaximal walking economy and maximal walking performance, without significant changes in maximal walking economy. Enhanced walking economy may contribute to physiological efficiency, which in turn may improve walking performance as demonstrated by PAD-IC patients following regular exercise programs.

Brain Network Modularity Predicts Exercise-Related Executive Function Gains in Older Adults

PubMed Central

Baniqued, Pauline L.; Gallen, Courtney L.; Voss, Michelle W.; Burzynska, Agnieszka Z.; Wong, Chelsea N.; Cooke, Gillian E.; Duffy, Kristin; Fanning, Jason; Ehlers, Diane K.; Salerno, Elizabeth A.; Aguiñaga, Susan; McAuley, Edward; Kramer, Arthur F.; D'Esposito, Mark

2018-01-01

Recent work suggests that the brain can be conceptualized as a network comprised of groups of sub-networks or modules. The extent of segregation between modules can be quantified with a modularity metric, where networks with high modularity have dense connections within modules and sparser connections between modules. Previous work has shown that higher modularity predicts greater improvements after cognitive training in patients with traumatic brain injury and in healthy older and young adults. It is not known, however, whether modularity can also predict cognitive gains after a physical exercise intervention. Here, we quantified modularity in older adults (N = 128, mean age = 64.74) who underwent one of the following interventions for 6 months (NCT01472744 on ClinicalTrials.gov): (1) aerobic exercise in the form of brisk walking (Walk), (2) aerobic exercise in the form of brisk walking plus nutritional supplement (Walk+), (3) stretching, strengthening and stability (SSS), or (4) dance instruction. After the intervention, the Walk, Walk+ and SSS groups showed gains in cardiorespiratory fitness (CRF), with larger effects in both walking groups compared to the SSS and Dance groups. The Walk, Walk+ and SSS groups also improved in executive function (EF) as measured by reasoning, working memory, and task-switching tests. In the Walk, Walk+, and SSS groups that improved in EF, higher baseline modularity was positively related to EF gains, even after controlling for age, in-scanner motion and baseline EF. No relationship between modularity and EF gains was observed in the Dance group, which did not show training-related gains in CRF or EF control. These results are consistent with previous studies demonstrating that individuals with a more modular brain network organization are more responsive to cognitive training. These findings suggest that the predictive power of modularity may be generalizable across interventions aimed to enhance aspects of cognition and that, especially in low-performing individuals, global network properties can capture individual differences in neuroplasticity. PMID:29354050

Development of a Portable Gait Rehabilitation System for Home-Visit Rehabilitation

PubMed Central

Yano, Hiroaki; Tanaka, Naoki; Kamibayashi, Kiyotaka; Saitou, Hideyuki; Iwata, Hiroo

2015-01-01

This paper describes the development of a gait rehabilitation system with a locomotion interface (LI) for home-visit rehabilitation. For this purpose, the LI should be compact, small, and easy to move. The LI has two 2 degree-of-freedom (DOF) manipulators with footpads to move each foot along a trajectory. When the user stands on the footpads, the system can move his or her feet while the body remains stationary. The footpads can have various trajectories, which are prerecordings of the movements of healthy individuals walking on plane surfaces or slopes. The homes of stroke patients may have not only flat surfaces but also some slopes and staircases. The quadriceps femoris muscle is important for walking up and down slopes and staircases, and the eccentric and concentric contractions of this muscle are, in particular, difficult to train under normal circumstances. Therefore, we developed a graded-walking program for the system used in this study. Using this system, the user can undergo gait rehabilitation in their home, during visits by a physical therapist. An evaluation of the results of tests showed that the vastus medialis muscles of all the subjects were stimulated more than by walking on real slopes. PMID:25945364

Formative Process Evaluation for Implementing a Social Marketing Intervention to Increase Walking Among African Americans in the Positive Action for Today’s Health Trial

PubMed Central

Wilson, Dawn K.; Griffin, Sarah; St. George, Sara M.; Alia, Kassandra A.; Trumpeter, Nevelyn N.; Wandersman, Abraham K.; Forthofer, Melinda; Robinson, Shamika; Gadson, Barney

2012-01-01

Objectives. Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today’s Health trial. Methods: We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months. Results: Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating. Conclusions: Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities. PMID:23078486

Gait retraining using real-time feedback in patients with medial knee osteoarthritis: Feasibility and effects of a six-week gait training program.

PubMed

Richards, R; van den Noort, J C; van der Esch, M; Booij, M J; Harlaar, J

2018-06-20

The knee adduction moment (KAM) is often elevated in medial knee osteoarthritis (KOA). The aim of this study was to evaluate effects on KAM and patient-reported outcomes of a six-week gait training program. Twenty-one patients (61 ± 6 years) with KOA participated in a six-week biofeedback training program to encourage increased toe-in (all patients) and increased step-width (five patients). Patients received real-time visual feedback while walking on an instrumented treadmill. We analysed the effect of the gait modification(s) on peak KAM in week six and three and six months post-training. We also evaluated the effect on pain and functional ability. Of 21 patients starting the program, 16 completed it with high attendance (15 and 16 respectively) at the three and six month follow-ups. First peak KAM was significantly reduced by up to 14.0% in week six with non-significant reductions of 8.2% and 5.5% at the follow-ups. Functional ability (assessed using the WOMAC questionnaire) improved significantly after the training (eight point reduction, p = 0.04 in week six and nine point reduction, p = 0.04 at six-month follow-up). There was also a trend towards reduction in WOMAC pain (p = 0.06) at follow-up. Biofeedback training to encourage gait modifications is feasible and leads to short-term benefits. However, at follow-up, reductions in KAM were less pronounced in some participants suggesting that to influence progression of KOA in the longer term, a permanent regime to reinforce the effects of the training program is needed. Trial number: ISRCTN14687588. Copyright © 2018 Elsevier B.V. All rights reserved.

Lower limb joint work and joint work contribution during downhill and uphill walking at different inclinations.

PubMed

Alexander, Nathalie; Strutzenberger, Gerda; Ameshofer, Lisa Maria; Schwameder, Hermann

2017-08-16

Work performance and individual joint contribution to total work are important information for creating training protocols, but were not assessed so far for sloped walking. Therefore, the purpose of this study was to analyze lower limb joint work and joint contribution of the hip, knee and ankle to total lower limb work during sloped walking in a healthy population. Eighteen male participants (27.0±4.7yrs, 1.80±0.05m, 74.5±8.2kg) walked on an instrumented ramp at inclination angles of 0°, ±6°, ±12° and ±18° at 1.1m/s. Kinematic and kinetic data were captured using a motion-capture system (Vicon) and two force plates (AMTI). Joint power curves, joint work (positive, negative, absolute) and each joint's contribution to total lower limb work were analyzed throughout the stance phase using an ANOVA with repeated measures. With increasing inclination positive joint work increased for the ankle and hip joint and in total during uphill walking. Negative joint work increased for each joint and in total work during downhill walking. Absolute work was increased during both uphill (all joints) and downhill (ankle & knee) walking. Knee joint contribution to total negative and absolute work increased during downhill walking while hip and ankle contributions decreased. This study identified, that, when switching from level to a 6° and from 6° to a 12° inclination the gain of individual joint work is more pronounced compared to switching from 12° to an 18° inclination. The results might be used for training recommendations and specific training intervention with respect to sloped walking. Copyright © 2017 Elsevier Ltd. All rights reserved.

A mechanized gait trainer for restoring gait in nonambulatory subjects.

PubMed

Hesse, S; Uhlenbrock, D; Werner, C; Bardeleben, A

2000-09-01

To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. Four weeks of training, five times a week, each session 20 minutes long. Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.

Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial.

PubMed

Morone, Giovanni; Annicchiarico, Roberta; Iosa, Marco; Federici, Alessia; Paolucci, Stefano; Cortés, Ulises; Caltagirone, Carlo

2016-05-26

Patients affected by mild stroke benefit more from physiological overground walking training than walking-like training performed in place using specific devices. The aim of the study was to evaluate the effects of overground robotic walking training performed with the servo-assistive robotic rollator (i-Walker) on walking, balance, gait stability and falls in a community setting in patients with mild subacute stroke. Forty-four patients were randomly assigned to two different groups that received the same therapy in two daily 40-min sessions 5 days a week for 4 weeks. Twenty sessions of standard therapy were performed by both groups. In the other 20 sessions the subjects enrolled in the i-Walker-Group (iWG) performed with the i-Walker and the Control-Group patients (CG) performed the same amount of conventional walking oriented therapy. Clinical and instrumented gait assessments were made pre- and post-treatment. The follow-up observation consisted of recording the number of fallers in the community setting after 6 months. Treatment effectiveness was higher in the iWG group in terms of balance improvement (Tinetti: 68.4 ± 27.6 % vs. 48.1 ± 33.9 %, p = 0.033) and 10-m and 6-min timed walking tests (significant interaction between group and time: F(1,40) = 14.252, p = 0.001; and F(1,40) = 7.883, p = 0.008, respectively). When measured, latero-lateral upper body accelerations were reduced in iWG (F = 4.727, p = 0.036), suggesting increased gait stability, which was supported by a reduced number of falls at home. A robotic servo-assisted i-Walker improved walking performance and balance in patients affected by mild/moderate stroke, leading to increased gait stability and reduced falls in the community. This study was registered on anzctr.org.au (July 1, 2015; ACTRN12615000681550 ).

The effect of a walking program on perceived benefits and barriers to exercise in postmenopausal African American women.

PubMed

Williams, Bernadette R; Bezner, Janet; Chesbro, Steven B; Leavitt, Ronnie

2006-01-01

Rates of exercise participation among African Americans is low. Identifying and overcoming perceived benefits/ barriers unique to African American women (AAW) may increase their exercise participation. The purpose of this study was to describe perceived benefits/barriers to exercise in AAW before and after participation in a walking program. Thirty-five postmenopausal AAW participated in a 7-week structured walking program with 2 walking goals. Perceived benefits and barriers to exercise were assessed using the Exercise Benefits/Barriers Scale at the beginning and end of the program. Participants engaged in a postintervention interview to further assess benefits/barriers to exercise participation. Perceived benefits/barriers to exercise did not change significantly with participation in a walking program. Lack of time due to work and family responsibilities affected achievement of the brisk walking goal. Postmenopausal AAW in this study strongly believed in the benefits of exercising and had increased levels of participation in a walking program when lack of time was not a barrier. Overcoming this barrier is the true challenge to health care professionals.

Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury.

PubMed

Varoqui, Deborah; Niu, Xun; Mirbagheri, Mehdi M

2014-03-31

In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities-characterized by increases in the over-ground walking speed and endurance-is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients. Fifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient's maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients. After the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments. The improvements of the kinematic and kinetic parameters of the ankle voluntary movement, and their correlation with the functional assessments, support the therapeutic effect of robotic-assisted locomotor training on motor impairment in chronic iSCI.

Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial.

PubMed

Hollands, Kristen L; Pelton, Trudy A; Wimperis, Andrew; Whitham, Diane; Tan, Wei; Jowett, Sue; Sackley, Catherine M; Wing, Alan M; Tyson, Sarah F; Mathias, Jonathan; Hensman, Marianne; van Vliet, Paulette M

2015-01-01

Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke. This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services. Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments. Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks. Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up. Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms. Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention. Clinicaltrials.gov NCT01600391.

Astronaut Linda Godwin during contingency EVA training in WETF

NASA Image and Video Library

1993-08-17

S93-41574 (17 Aug 1993) --- Astronaut Linda M. Godwin, payload commander, prepares to be submerged in a 25-feet deep pool at the Johnson Space Center's (JSC) Weightless Environment Training Facility (WET-F). Astronauts Godwin and Thomas D. Jones (out of frame at left), mission specialist, are using the WET-F to train for contingency space walks for their STS-59 Space Shuttle Endeavour mission next year. No space walks are planned for the flight.

An integrated gait rehabilitation training based on Functional Electrical Stimulation cycling and overground robotic exoskeleton in complete spinal cord injury patients: Preliminary results.

PubMed

Mazzoleni, S; Battini, E; Rustici, A; Stampacchia, G

2017-07-01

The aim of this study is to investigate the effects of an integrated gait rehabilitation training based on Functional Electrical Stimulation (FES)-cycling and overground robotic exoskeleton in a group of seven complete spinal cord injury patients on spasticity and patient-robot interaction. They underwent a robot-assisted rehabilitation training based on two phases: n=20 sessions of FES-cycling followed by n= 20 sessions of robot-assisted gait training based on an overground robotic exoskeleton. The following clinical outcome measures were used: Modified Ashworth Scale (MAS), Numerical Rating Scale (NRS) on spasticity, Penn Spasm Frequency Scale (PSFS), Spinal Cord Independence Measure Scale (SCIM), NRS on pain and International Spinal Cord Injury Pain Data Set (ISCI). Clinical outcome measures were assessed before (T0) after (T1) the FES-cycling training and after (T2) the powered overground gait training. The ability to walk when using exoskeleton was assessed by means of 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Timed Up and Go test (TUG), standing time, walking time and number of steps. Statistically significant changes were found on the MAS score, NRS-spasticity, 6MWT, TUG, standing time and number of steps. The preliminary results of this study show that an integrated gait rehabilitation training based on FES-cycling and overground robotic exoskeleton in complete SCI patients can provide a significant reduction of spasticity and improvements in terms of patient-robot interaction.

Effects of perturbation-based slip training using a virtual reality environment on slip-induced falls.

PubMed

Parijat, Prakriti; Lockhart, Thurmon E; Liu, Jian

2015-04-01

The purpose of the current study was to design and evaluate the effectiveness of virtual reality training in improving recovery reactions and reducing fall frequency in older adults. Twenty-four older adults were recruited and randomly assigned to two groups (virtual reality training and control). Both groups underwent three sessions including baseline slip, training and transfer of training on slippery surface. Both groups experienced two slips, one during baseline and the other during the transfer of training trial. The training group underwent 12 simulated slips using a visual perturbation induced by tilting a virtual reality scene while walking on the treadmill and the control group performed normal walking during the training session. Kinematic and kinetic data were collected during all the sessions. Results demonstrated a reduced incidence of falls in the training group during the transfer of training trial as compared to the control group. The training group was able to transfer reactive control strategies learned during training to the second slip trial. The reactive adjustments included reduced slip distance. Additionally, gait parameters reflective of gait instability (stride length, step width, variability in stride velocity) reduced after walking in the VR environment for 15-20 min. The results indicated a beneficial effect of the virtual reality training in reducing slip severity and recovery kinematics in healthy older adults.

Effects of Perturbation-Based Slip Training using a Virtual Reality Environment on Slip-induced Falls

PubMed Central

Parijat, Prakriti; Lockhart, Thurmon E.; Liu, Jian

2015-01-01

The purpose of the current study was to design and evaluate the effectiveness of virtual reality training in improving recovery reactions and reducing fall frequency in older adults. Twenty-four older adults were recruited and randomly assigned to two groups (virtual reality training and control). Both groups underwent three sessions including baseline slip, training and transfer of training on slippery surface. Both groups experienced two slips, one during baseline and the other during the transfer of training trial. The training group underwent twelve simulated slips using a visual perturbation induced by tilting a virtual reality scene while walking on the treadmill and the control group performed normal walking during the training session. Kinematic and kinetic data were collected during all the sessions. Results demonstrated a reduced incidence of falls in the training group during the transfer of training trial as compared to the control group. The training group was able to transfer reactive control strategies learned during training to the second slip trial. The reactive adjustments included reduced slip distance. Additionally, gait parameters reflective of gait instability (stride length, step width, variability in stride velocity) reduced after walking in the VR environment for 15–20 min. The results indicated a beneficial effect of the virtual reality training in reducing slip severity and recovery kinematics in healthy older adults. PMID:25245221

Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study.

PubMed

Lans, Charlotta; Cider, Åsa; Nylander, Eva; Brudin, Lars

2018-04-01

This study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home-based programme. Twenty-two patients with stable CHF (19 men and 3 women), mean age 63.2 years (SD 8.1), New York Heart Association class II-III were randomized to individual home-based training (HT group), or home-based training with a group-based start-up in a hospital setting (GT group). A 6 min walk test, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Short Form with 36 items (SF-36) were administered at baseline and after 3, 6, 9, and 12 months. Exercise training resulted in statistically significant increased walking distance in both groups. The HT group increased on average 107 (80) m from baseline to 12 months, and the GT group by 100 (96) m. Health-related quality of life, measured with MLHFQ and SF-36, reached statistically significant improvements in both groups but at different time points. There were no statistically significant differences between groups on any parameters or follow-ups. Long-term home-based peripheral muscle training in patients with CHF, with or without an introductory period in a hospital setting, can be used for initial improvement and retention of walking distance and health-related quality of life. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Dynamic Neuro-Cognitive Imagery Improves Mental Imagery Ability, Disease Severity, and Motor and Cognitive Functions in People with Parkinson's Disease

PubMed Central

Hart, Ariel; Andrade, Isaac; Hackney, Madeleine E.

2018-01-01

People with Parkinson's disease (PD) experience kinesthetic deficits, which affect motor and nonmotor functions, including mental imagery. Imagery training is a recommended, yet underresearched, approach in PD rehabilitation. Dynamic Neuro-Cognitive Imagery (DNI™) is a codified method for imagery training. Twenty subjects with idiopathic PD (Hoehn and Yahr stages I–III) were randomly allocated into DNI training (experimental; n = 10) or in-home learning and exercise program (control; n = 10). Both groups completed at least 16 hours of training within two weeks. DNI training focused on anatomical embodiment and kinesthetic awareness. Imagery abilities, disease severity, and motor and nonmotor functions were assessed pre- and postintervention. The DNI participants improved (p < .05) in mental imagery abilities, disease severity, and motor and spatial cognitive functions. Participants also reported improvements in balance, walking, mood, and coordination, and they were more physically active. Both groups strongly agreed they enjoyed their program and were more mentally active. DNI training is a promising rehabilitation method for improving imagery ability, disease severity, and motor and nonmotor functions in people with PD. This training might serve as a complementary PD therapeutic approach. Future studies should explore the effect of DNI on motor learning and control strategies. PMID:29725348

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness.

PubMed

Basso-Vanelli, Renata P; Di Lorenzo, Valéria A Pires; Labadessa, Ivana G; Regueiro, Eloisa M G; Jamami, Mauricio; Gomes, Evelim L F D; Costa, Dirceu

2016-01-01

Patients with COPD may experience respiratory muscle weakness. Two therapeutic approaches to the respiratory muscles are inspiratory muscle training and calisthenics-and-breathing exercises. The aims of the study are to compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion. In addition, these gains were compared between subjects with and without respiratory muscle weakness. 25 subjects completed the study: 13 composed the inspiratory muscle training group, and 12 composed the calisthenics-and-breathing exercises group. Subjects were assessed before and after training by spirometry, measurements of respiratory muscle strength and test of inspiratory muscle endurance, thoracoabdominal excursion measurements, and the 6-min walk test. Moreover, scores for the Modified Medical Research Council dyspnea scale were reported. After intervention, there was a significant improvement in both groups of respiratory muscle strength and endurance, thoracoabdominal mobility, and walking distance in the 6-min walk test. Additionally, there was a decrease of dyspnea in the 6-min walk test peak. A difference was found between groups, with higher values of respiratory muscle strength and thoracoabdominal mobility and lower values of dyspnea in the 6-min walk test peak and the Modified Medical Research Council dyspnea scale in the inspiratory muscle training group. In the inspiratory muscle training group, subjects with respiratory muscle weakness had greater gains in inspiratory muscle strength and endurance. Both interventions increased exercise capacity and decreased dyspnea during physical effort. However, inspiratory muscle training was more effective in increasing inspiratory muscle strength and endurance, which could result in a decreased sensation of dyspnea. In addition, subjects with respiratory muscle weakness that performed inspiratory muscle training had higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity. (ClinicalTrials.gov registration NCT01510041.). Copyright © 2016 by Daedalus Enterprises.

The Effects on Kinematics and Muscle Activity of Walking in a Robotic Gait Trainer During Zero-Force Control.

PubMed

van Asseldonk, Edwin H F; Veneman, Jan F; Ekkelenkamp, Ralf; Buurke, Jaap H; van der Helm, Frans C T; van der Kooij, Herman

2008-08-01

"Assist as needed" control algorithms promote activity of patients during robotic gait training. Implementing these requires a free walking mode of a device, as unassisted motions should not be hindered. The goal of this study was to assess the normality of walking in the free walking mode of the LOPES gait trainer, an 8 degrees-of-freedom lightweight impedance controlled exoskeleton. Kinematics, gait parameters and muscle activity of walking in a free walking mode in the device were compared with those of walking freely on a treadmill. Average values and variability of the spatio-temporal gait variables showed no or small (relative to cycle-to-cycle variability) changes and the kinematics showed a significant and relevant decrease in knee angle range only. Muscles involved in push off showed a small decrease, whereas muscles involved in acceleration and deceleration of the swing leg showed an increase of their activity. Timing of the activity was mainly unaffected. Most of the observed differences could be ascribed to the inertia of the exoskeleton. Overall, walking with the LOPES resembled free walking, although this required several adaptations in muscle activity. These adaptations are such that we expect that Assist as Needed training can be implemented in LOPES.

Use of formative research and social network theory to develop a group walking intervention: Sumter County on the Move!

PubMed

Forthofer, Melinda; Burroughs-Girardi, Ericka; Stoisor-Olsson, Liliana; Wilcox, Sara; Sharpe, Patricia A; Pekuri, Linda M

2016-10-01

Although social support is a frequently cited enabler of physical activity, few studies have examined how to harness social support in interventions. This paper describes community-based formative research to design a walking program for mobilizing naturally occurring social networks to support increases in walking behavior. Focus group methods were used to engage community members in discussions about desired walking program features. The research was conducted with underserved communities in Sumter County, South Carolina. The majority of focus group participants were women (76%) and African American (92%). Several important themes emerged from the focus group results regarding attitudes toward walking, facilitators of and barriers to walking, ideal walking program characteristics, and strategies for encouraging community members to walk. Most noteably, the role of existing social networks as a supportive influence on physical activity was a recurring theme in our formative research and a gap in the existing evidence base. The resulting walking program focused on strategies for mobilizing, supporting and reinforcing existing social networks as mechanisms for increasing walking. Our approach to linking theory, empirical evidence and community-based formative research for the development of a walking intervention offers an example for practitioners developing intervention strategies for a wide range of behaviors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of nordic walking and water aerobics training on body composition and the blood flow in lower extremities in elderly women.

PubMed

Jasiński, Ryszard; Socha, Małgorzata; Sitko, Ludmiła; Kubicka, Katarzyna; Woźniewski, Marek; Sobiech, Krzysztof A

2015-03-29

Nordic walking and water aerobics are very popular forms of physical activity in the elderly population. The aim of the study was to evaluate the influence of regular health training on the venous blood flow in lower extremities and body composition in women over 50 years old. Twenty-four women of mean age 57.9 (± 3.43) years, randomly divided into three groups (Nordic walking, water aerobics, and non-training), participated in the study. The training lasted 8 weeks, with one-hour sessions twice a week. Dietary habits were not changed. Before and after training vein refilling time and the function of the venous pump of the lower extremities were measured by photoplethysmography. Body composition was determined by bioelectrical impedance. Eight weeks of Nordic walking training improved the venous blood flow in lower extremities and normalized body composition in the direction of reducing chronic venous disorder risk factors. The average values of the refilling time variable (p = 0.04, p = 0.02, respectively) decreased in both the right and the left leg. After training a statistically significant increase in the venous pump function index was found only in the right leg (p = 0.04). A significant increase in fat-free mass, body cell mass and total body water was observed (p = 0.01), whereas body mass, the body mass index, and body fat decreased (p < 0.03). With regard to water aerobic training, no similar changes in the functions of the venous system or body composition were observed.

Decrease of spasticity after hybrid assistive limb® training for a patient with C4 quadriplegia due to chronic SCI.

PubMed

Ikumi, Akira; Kubota, Shigeki; Shimizu, Yukiyo; Kadone, Hideki; Marushima, Aiki; Ueno, Tomoyuki; Kawamoto, Hiroaki; Hada, Yasushi; Matsumura, Akira; Sankai, Yoshiyuki; Yamazaki, Masashi

2017-09-01

Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia. The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation. There was muscle atrophy under C5 level and no sensation around the anus, but partial sensation of pressure remained in the limbs. The American Spinal Injury Association impairment scale was Grade A (complete motor C4 lesion). HAL training was administered in 10 sessions (twice per week). The training sessions consisted of treadmill walking with HAL. For safety, 2 physicians and 1 therapist supported the subject for balance and weight-bearing. The device's cybernic autonomous control mode provides autonomic physical support based on predefined walking patterns. We evaluated the adverse events, walking time and distance, and the difference in muscle spasticity before and after HAL-training using a modified Ashworth scale (mAs). No adverse events were observed that required discontinuation of rehabilitation. Walking distance and time increased from 25.2 meters/7.6 minutes to 148.3 meter/15 minutes. The mAs score decreased after HAL training. Our case report indicates that HAL training is feasible and effective for complete C4 quadriplegia in chronic SCI.

V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial.

PubMed

Mirelman, Anat; Rochester, Lynn; Reelick, Miriam; Nieuwhof, Freek; Pelosin, Elisa; Abbruzzese, Giovanni; Dockx, Kim; Nieuwboer, Alice; Hausdorff, Jeffrey M

2013-02-06

Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits. Indeed, everyday walking in complex environments utilizes executive function, dual tasking, planning and scanning, all while walking forward. Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction. The proposed randomized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk. Three hundred older adults with a history of falls will be recruited to participate in this study. This will include older adults (n=100), patients with mild cognitive impairment (n=100), and patients with Parkinson's disease (n=100). These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits. Subjects will be randomly assigned to the intervention group (treadmill training with virtual reality) or to the active-control group (treadmill training without virtual reality). Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks. Assessments will take place before, after, and 1 month and 6 months after the completion of the training. A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence (i.e., the number of falls, multiple falls and falls rate). In addition, we will measure gait under usual and dual task conditions, balance, community mobility, health related quality of life, user satisfaction and cognitive function. This randomized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality reduces fall risk, improves mobility and enhances cognitive function in a diverse group of older adults. In addition, the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit. (NIH)-NCT01732653.

V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial

PubMed Central

2013-01-01

Background Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits. Indeed, everyday walking in complex environments utilizes executive function, dual tasking, planning and scanning, all while walking forward. Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction. The proposed randomized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk. Methods/Design Three hundred older adults with a history of falls will be recruited to participate in this study. This will include older adults (n=100), patients with mild cognitive impairment (n=100), and patients with Parkinson’s disease (n=100). These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits. Subjects will be randomly assigned to the intervention group (treadmill training with virtual reality) or to the active-control group (treadmill training without virtual reality). Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks. Assessments will take place before, after, and 1 month and 6 months after the completion of the training. A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence (i.e., the number of falls, multiple falls and falls rate). In addition, we will measure gait under usual and dual task conditions, balance, community mobility, health related quality of life, user satisfaction and cognitive function. Discussion This randomized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality reduces fall risk, improves mobility and enhances cognitive function in a diverse group of older adults. In addition, the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit. Trial Registration (NIH)–NCT01732653 PMID:23388087

Cognitive Resources Necessary for Motor Control in Older Adults Are Reduced by Walking and Coordination Training

PubMed Central

Godde, Ben; Voelcker-Rehage, Claudia

2017-01-01

We examined if physical exercise interventions were effective to reduce cognitive brain resources recruited while performing motor control tasks in older adults. Forty-three older adults (63–79 years of age) participated in either a walking (n = 17) or a motor coordination (n = 15) intervention (1 year, 3 times per week) or were assigned to a control group (n = 11) doing relaxation and stretching exercises. Pre and post the intervention period, we applied functional MRI to assess brain activation during imagery of forward and backward walking and during counting backwards from 100 as control task. In both experimental groups, activation in the right dorsolateral prefrontal cortex (DLPFC) during imagery of forward walking decreased from pre- to post-test (Effect size: −1.55 and −1.16 for coordination and walking training, respectively; Cohen’s d). Regression analysis revealed a significant positive association between initial motor status and activation change in the right DLPFC (R2 = 0.243, F(3,39) = 4.18, p = 0.012). Participants with lowest motor status at pretest profited most from the interventions. Data suggest that physical training in older adults is effective to free up cognitive resources otherwise needed for the control of locomotion. Training benefits may become particularly apparent in so-called dual-task situations where subjects must perform motor and cognitive tasks concurrently. PMID:28443006

Effects of a short burst of gait training with body weight-supported treadmill training for a person with chronic stroke: a single-subject study.

PubMed

Combs, Stephanie A; Miller, Ellen Winchell

2011-04-01

The purpose of this study was to investigate the effects of a short-burst dose of intense gait training with body weight-supported treadmill training (BWSTT) on walking speed, endurance, and quality of life of a participant with chronic stroke. A single-subject experimental (A-B-A-A) design with immediate and 3-month retention phases was used. The participant was a 66-year-old woman, 1 year after left cerebrovascular accident. Repeated baseline walking performance was established during 2 weeks of testing using the comfortable 10-meter walk test (CWT) and the 6-minute walk test (6MWT). The Stroke Impact Scale (SIS) was measured one time during baseline. Baseline testing was followed by ten 30-minute sessions of BWSTT over a 2-week duration. Retention testing was conducted immediately and 3 months following the intervention. Statistically significant improvements from baseline with the CWT and the 6MWT were achieved and maintained by the participant across all subsequent measurement phases. Improvements considered to be clinically meaningful changes in the SIS domains of strength and mobility achieved immediately after the intervention were not maintained at 3-month retention testing. For the participant in this study, the short-burst dosage of BWSTT provided a feasible and effective means for improving goal-oriented functional walking ability.

Adaptive locomotor training on an end-effector gait robot: evaluation of the ground reaction forces in different training conditions.

PubMed

Tomelleri, Christopher; Waldner, Andreas; Werner, Cordula; Hesse, Stefan

2011-01-01

The main goal of robotic gait rehabilitation is the restoration of independent gait. To achieve this goal different and specific patterns have to be practiced intensively in order to stimulate the learning process of the central nervous system. The gait robot G-EO Systems was designed to allow the repetitive practice of floor walking, stair climbing and stair descending. A novel control strategy allows training in adaptive mode. The force interactions between the foot and the ground were analyzed on 8 healthy volunteers in three different conditions: real floor walking on a treadmill, floor walking on the gait robot in passive mode, floor walking on the gait robot in adaptive mode. The ground reaction forces were measured by a Computer Dyno Graphy (CDG) analysis system. The results show different intensities of the ground reaction force across all of the three conditions. The intensities of force interactions during the adaptive training mode are comparable to the real walking on the treadmill. Slight deviations still occur in regard to the timing pattern of the forces. The adaptive control strategy comes closer to the physiological swing phase than the passive mode and seems to be a promising option for the treatment of gait disorders. Clinical trials will validate the efficacy of this new option in locomotor therapy on the patients. © 2011 IEEE

Retraining walking adaptability following incomplete spinal cord injury.

PubMed

Fox, Emily J; Tester, Nicole J; Butera, Katie A; Howland, Dena R; Spiess, Martina R; Castro-Chapman, Paula L; Behrman, Andrea L

2017-01-01

Functional walking requires the ability to modify one's gait pattern to environmental demands and task goals-gait adaptability. Following incomplete spinal cord injury (ISCI), gait rehabilitation such as locomotor training (Basic-LT) emphasizes intense, repetitive stepping practice. Rehabilitation approaches focusing on practice of gait adaptability tasks have not been established for individuals with ISCIs but may promote recovery of higher level walking skills. The primary purpose of this case series was to describe and determine the feasibility of administering a gait adaptability retraining approach-Adapt-LT-by comparing the dose and intensity of Adapt-LT to Basic-LT. Three individuals with ISCIs (>1 year, AIS C or D) completed three weeks each (15 sessions) of Basic-LT and Adapt-LT. Interventions included practice on a treadmill with body weight support and practice overground (≥30 mins total). Adapt-LT focused on speed changes, obstacle negotiation, and backward walking. Training parameters (step counts, speeds, perceived exertion) were compared and outcomes assessed pre and post interventions. Based on completion of the protocol and similarities in training parameters in the two interventions, it was feasible to administer Adapt-LT with a similar dosage and intensity as Basic-LT. Additionally, the participants demonstrated gains in walking function and balance following each training type. Rehabilitation that includes stepping practice with adaptability tasks is feasible for individuals with ISCIs. Further investigation is needed to determine the efficacy of Adapt-LT.

High intensity interval exercise training in overweight young women.

PubMed

Sijie, T; Hainai, Y; Fengying, Y; Jianxiong, W

2012-06-01

The purpose of this study was intended to evaluate the effects of a high intensity interval training (HIIT) program on the body composition, cardiac function and aerobic capacity in overweight young women. Sixty female university students (aged 19-20, BMI≥25kg/m2 and percentage body fat ≥ 30%) were chosen and then randomly assigned to each of the HIIT group, the moderate intensity continuous training (MICT) group and the non-training control group. The subjects in both the HIIT and MICT groups underwent exercise training five times per week for 12 weeks. In each of the training sessions, the HIIT group performed interval exercises at the individualized heart rate (HR) of 85% of VO2max and separated by brief periods of low intensity activity (HR at 50% of VO2max), while the MICT group did continuous walking and/or jogging at the individualized HR of 50% of VO2max. Both of these exercise training programs produced significant improvements in the subjects' body composition, left ventricular ejection fraction, heart rate at rest, maximal oxygen uptake and ventilatory threshold. However, the HIIT group achieved better results than those in the MICT group, as it was evaluated by the amount of the effect size. The control group did not achieve any change in all of the measured variables. The tangible results achieved by our relatively large groups of homogeneous subjects have demonstrated that the HIIT program is an effective measure for the treatment of young women who are overweight.

Eye Movement Training and Suggested Gaze Strategies in Tunnel Vision - A Randomized and Controlled Pilot Study.

PubMed

Ivanov, Iliya V; Mackeben, Manfred; Vollmer, Annika; Martus, Peter; Nguyen, Nhung X; Trauzettel-Klosinski, Susanne

2016-01-01

Degenerative retinal diseases, especially retinitis pigmentosa (RP), lead to severe peripheral visual field loss (tunnel vision), which impairs mobility. The lack of peripheral information leads to fewer horizontal eye movements and, thus, diminished scanning in RP patients in a natural environment walking task. This randomized controlled study aimed to improve mobility and the dynamic visual field by applying a compensatory Exploratory Saccadic Training (EST). Oculomotor responses during walking and avoiding obstacles in a controlled environment were studied before and after saccade or reading training in 25 RP patients. Eye movements were recorded using a mobile infrared eye tracker (Tobii glasses) that measured a range of spatial and temporal variables. Patients were randomly assigned to two training conditions: Saccade (experimental) and reading (control) training. All subjects who first performed reading training underwent experimental training later (waiting list control group). To assess the effect of training on subjects, we measured performance in the training task and the following outcome variables related to daily life: Response Time (RT) during exploratory saccade training, Percent Preferred Walking Speed (PPWS), the number of collisions with obstacles, eye position variability, fixation duration, and the total number of fixations including the ones in the subjects' blind area of the visual field. In the saccade training group, RTs on average decreased, while the PPWS significantly increased. The improvement persisted, as tested 6 weeks after the end of the training. On average, the eye movement range of RP patients before and after training was similar to that of healthy observers. In both, the experimental and reading training groups, we found many fixations outside the subjects' seeing visual field before and after training. The average fixation duration was significantly shorter after the training, but only in the experimental training condition. We conclude that the exploratory saccade training was beneficial for RP patients and resulted in shorter fixation durations after the training. We also found a significant improvement in relative walking speed during navigation in a real-world like controlled environment.

Eye Movement Training and Suggested Gaze Strategies in Tunnel Vision - A Randomized and Controlled Pilot Study

PubMed Central

Ivanov, Iliya V.; Mackeben, Manfred; Vollmer, Annika; Martus, Peter; Nguyen, Nhung X.; Trauzettel-Klosinski, Susanne

2016-01-01

Purpose Degenerative retinal diseases, especially retinitis pigmentosa (RP), lead to severe peripheral visual field loss (tunnel vision), which impairs mobility. The lack of peripheral information leads to fewer horizontal eye movements and, thus, diminished scanning in RP patients in a natural environment walking task. This randomized controlled study aimed to improve mobility and the dynamic visual field by applying a compensatory Exploratory Saccadic Training (EST). Methods Oculomotor responses during walking and avoiding obstacles in a controlled environment were studied before and after saccade or reading training in 25 RP patients. Eye movements were recorded using a mobile infrared eye tracker (Tobii glasses) that measured a range of spatial and temporal variables. Patients were randomly assigned to two training conditions: Saccade (experimental) and reading (control) training. All subjects who first performed reading training underwent experimental training later (waiting list control group). To assess the effect of training on subjects, we measured performance in the training task and the following outcome variables related to daily life: Response Time (RT) during exploratory saccade training, Percent Preferred Walking Speed (PPWS), the number of collisions with obstacles, eye position variability, fixation duration, and the total number of fixations including the ones in the subjects' blind area of the visual field. Results In the saccade training group, RTs on average decreased, while the PPWS significantly increased. The improvement persisted, as tested 6 weeks after the end of the training. On average, the eye movement range of RP patients before and after training was similar to that of healthy observers. In both, the experimental and reading training groups, we found many fixations outside the subjects' seeing visual field before and after training. The average fixation duration was significantly shorter after the training, but only in the experimental training condition. Conclusions We conclude that the exploratory saccade training was beneficial for RP patients and resulted in shorter fixation durations after the training. We also found a significant improvement in relative walking speed during navigation in a real-world like controlled environment. PMID:27351629

Improving balance skills in patients who had stroke through virtual reality treadmill training.

PubMed

Yang, Saiwei; Hwang, Wei-Hsung; Tsai, Yi-Ching; Liu, Fu-Kang; Hsieh, Lin-Fen; Chern, Jen-Suh

2011-12-01

The aim of this study was to evaluate the effects of virtual reality (VR) treadmill training on the balance skills of patients who have had a stroke. A total of 14 patients with strokes were recruited and randomly assigned to receive VR treadmill or traditional treadmill training. The outcome measures that were included for the study were center of pressure (COP) sway excursion, COP maximum sway in anterior-posterior direction, COP maximum sway in medial-lateral direction, COP sway area, bilateral limb-loading symmetric index, the sway excursion values for the paretic foot (sway excursion/P), paretic limb stance time (stance time/P), number of steps of the paretic limb (number of steps/P), and contact area of the paretic foot (contact A/P) during quiet stance, sit-to-stand transfer, and level walking. There were no significant improvements in COP-related measures and symmetric index during the quiet stance, either in the VR treadmill or traditional treadmill training group (P > 0.05). However, the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant (P = 0.038). Traditional treadmill training failed to improve sit-to-stand performance, whereas VR treadmill training improved symmetric index (P = 0.028) and sway excursion (P = 0.046) significantly during sit-to-stand transfer. The changes of symmetric index between groups were markedly different (P = 0.045). Finally, both groups improved significantly in stance time/P, but only VR treadmill training increased contact A/P (P = 0.034) after training during level walking. The difference between groups during level walking was not significant. Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance, but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did. VR treadmill training also improved balance skill during sit-to-stand transfers and the involvement of paretic limb in level walking more than the traditional one did.

A novel walking speed estimation scheme and its application to treadmill control for gait rehabilitation.

PubMed

Yoon, Jungwon; Park, Hyung-Soon; Damiano, Diane Louise

2012-08-28

Virtual reality (VR) technology along with treadmill training (TT) can effectively provide goal-oriented practice and promote improved motor learning in patients with neurological disorders. Moreover, the VR + TT scheme may enhance cognitive engagement for more effective gait rehabilitation and greater transfer to over ground walking. For this purpose, we developed an individualized treadmill controller with a novel speed estimation scheme using swing foot velocity, which can enable user-driven treadmill walking (UDW) to more closely simulate over ground walking (OGW) during treadmill training. OGW involves a cyclic acceleration-deceleration profile of pelvic velocity that contrasts with typical treadmill-driven walking (TDW), which constrains a person to walk at a preset constant speed. In this study, we investigated the effects of the proposed speed adaptation controller by analyzing the gait kinematics of UDW and TDW, which were compared to those of OGW at three pre-determined velocities. Ten healthy subjects were asked to walk in each mode (TDW, UDW, and OGW) at three pre-determined speeds (0.5 m/s, 1.0 m/s, and 1.5 m/s) with real time feedback provided through visual displays. Temporal-spatial gait data and 3D pelvic kinematics were analyzed and comparisons were made between UDW on a treadmill, TDW, and OGW. The observed step length, cadence, and walk ratio defined as the ratio of stride length to cadence were not significantly different between UDW and TDW. Additionally, the average magnitude of pelvic acceleration peak values along the anterior-posterior direction for each step and the associated standard deviations (variability) were not significantly different between the two modalities. The differences between OGW and UDW and TDW were mainly in swing time and cadence, as have been reported previously. Also, step lengths between OGW and TDW were different for 0.5 m/s and 1.5 m/s gait velocities, and walk ratio between OGS and UDW was different for 1.0 m/s gait velocities. Our treadmill control scheme implements similar gait biomechanics of TDW, which has been used for repetitive gait training in a small and constrained space as well as controlled and safe environments. These results reveal that users can walk as stably during UDW as TDW and employ similar strategies to maintain walking speed in both UDW and TDW. Furthermore, since UDW can allow a user to actively participate in the virtual reality (VR) applications with variable walking velocity, it can induce more cognitive activities during the training with VR, which may enhance motor learning effects.

Gait training using a hybrid assistive limb (HAL) attenuates head drop: A case report.

PubMed

Miura, Kousei; Koda, Masao; Kadone, Hideki; Kubota, Shigeki; Shimizu, Yukiyo; Kumagai, Hiroshi; Nagashima, Katsuya; Mataki, Kentaro; Fujii, Kengo; Noguchi, Hiroshi; Funayama, Toru; Abe, Tetsuya; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-06-01

Dropped head syndrome (DHS) is characterized by a chin-on-chest deformity, which can severely interfere with forward vision and impair activities of daily living. A standardized treatment strategy for DHS has not been established. To our knowledge, this is the first case report describing the efficacy of gait training using a hybrid assistive limb (HAL) for DHS. A 75-year-old man showed apparent head drop in a standing position, resulting in passively reducible chin-on-chest deformity. A radiograph image showed apparent cervical kyphosis. Center of gravity of the head (CGH)-C7 SVA was +115 mm, CL was -40°, and T1S 39°. The patient underwent a treatment program using HAL, in which gait training was mainly performed, 60 min a day, 5 days a week for 2 weeks (10 sessions). After 2-3 sessions, dropped head started to attenuate. At the end of 10 sessions, the patient was able to walk with normal posture and radiograph images showed cervical kyphosis dramatically decreased because of HAL training. CGH-C7 SVA was 42 mm, CL was -1.7°, and T1S was 30°. Three months' outpatient follow-up revealed a slight deterioration of cervical alignment. However, the patient was able to maintain a better cervical alignment than before HAL training and keep walking with forward vision. There were no complications in any HAL treatment session. In conclusion, gait training using HAL is an option for treatment of DHS in addition to previously reported neck extensor muscle training. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Comparative efficacy of different regimens of locomotor training in long-term space flights by the data of biomechanical and electromyographic parametrs of walking].

PubMed

Shpakov, A V; Voronov, A V; Fomina, E V; Lysova, N Iu; Chernova, M V; Kozlovskaia, I B

2013-01-01

Biomechanical and electromyographic characteristics of locomotion were investigated before and after space flight on the 3rd, 7th and 10th day after landing in 18 cosmonauts--crewmembers of long-term ISS space flights. It was shown that microgravity causes the development of significant changes in biomechanical and electromyographic characteristics of walking. Decrease of the angular displacement amplitude in leg joints, reduction of the length of the double step, increase of the electromyographic cost of locomotion were recorded after flight. It was also shown that interval locomotor physical training in long-term space flights in the regimen of alternation running and walking prevents physiological cost of locomotor movements increase after space flight and provides more effective maintenance of the neuromuscular system functions after flight. After flight smaller changes of biomechanical and electromyographic characteristics of walking were observed in cosmonauts who used locomotor training in interval regimen.

Effects of strength training on muscle strength characteristics, functional capabilities, and balance in middle-aged and older women.

PubMed

Holviala, Jarkko H S; Sallinen, Janne M; Kraemer, William J; Alen, Markku J; Häkkinen, Keijo K T

2006-05-01

Progressive strength training can lead to substantial increases in maximal strength and mass of trained muscles, even in older women and men, but little information is available about the effects of strength training on functional capabilities and balance. Thus, the effects of 21 weeks of heavy resistance training--including lower loads performed with high movement velocities--twice a week on isometric maximal force (ISOmax) and force-time curve (force produced in 500 milliseconds, F0-500) and dynamic 1 repetition maximum (1RM) strength of the leg extensors, 10-m walking time (10WALK) and dynamic balance test (DYN.D) were investigated in 26 middle-aged (MI; 52.8 +/- 2.4 years) and 22 older women (O; 63.8 +/- 3.8 years). 1RM, ISOmax, and F0-500 increased significantly in MI by 28 +/- 10%, 20 +/- 19%, 31 +/- 34%, and in O by 27 +/- 8%, 20 +/- 16%, 18 +/- 45%, respectively. 10WALK (MI and O, p < 0.001) shortened and DYN.D improved (MI and O, p < 0.001). The present strength-training protocol led to large increases in maximal and explosive strength characteristics of leg extensors and in walking speed, as well to an improvement in the present dynamic balance test performance in both age groups. Although training-induced increase in explosive strength is an important factor for aging women, there are other factors that contribute to improvements in dynamic balance capacity. This study indicates that total body heavy resistance training, including explosive dynamic training, may be applied in rehabilitation or preventive exercise protocols in aging women to improve dynamic balance capabilities.

Water-based aerobic and combined training in elderly women: Effects on functional capacity and quality of life.

PubMed

Silva, Mariana Ribeiro; Alberton, Cristine Lima; Portella, Elisa Gouvêa; Nunes, Gabriela Neves; Martin, Daniela Gomez; Pinto, Stephanie Santana

2018-06-01

This study aimed to investigate the effects of two water-based training programs (aerobic and combined) and a non-periodized physical activity program on functional capacity and quality of life (QoL) of elderly women. Forty-one elderly female volunteers (65 ± 4 years) were divided into three groups: aerobic training group (WBA, n = 13), combined training (sequence: resistance/aerobic; WBC; n = 11) and a control group of non-periodized physical activity program (CG, n = 9). The participants performed the water-based trainings twice a week for 12 weeks. The resistance training sets were performed at maximal effort and the aerobic training was performed in the percentage of the heart rate corresponding to the anaerobic threshold (85-110%) determined in an aquatic progressive test. Assessments of QoL perception (WHOQOL-BREF) and functional tests 30-Second Chair Stand, 6-Minute Walk and 8-Foot Up-and-go were performed before and after training. The data were analyzed using Generalized Estimating Equations (GEE), and Bonferroni post-hoc test (α = 0.05). In CG, QoL perception in the physical domain decreased (12 ± 10%) and there was no difference in the other domains. On the other hand, QoL perception was significantly increased in the water-based training groups after the training period in the physical (WBC: 13 ± 16%), psychological (WBA: 9 ± 16%; WBC: 10 ± 11%), social relationships (WBA: 19 ± 42%; WBC: 16 ± 21%) and environmental (WBA: 10 ± 17%; WBC: 16 ± 28%) domains and overall QoL (WBA: 17 ± 22%). No significant difference was observed in the physical domain for WBA and in the overall for WBC. Significant improvements were observed for all groups in the functional tests 30-Second Chair Stand (WBA: 32 ± 11%; WBC: 24 ± 14%; CG: 20 ± 9), 6-Minute Walk (WBA: 10 ± 7%; WBC: 7 ± 6%; CG: 7 ± 5%) and 8-Foot Up-and-go (WBA: 11 ± 5%; WBC: 10 ± 9%; CG: 10 ± 6%). Based on the results observed in this study, it can be concluded that both water-based trainings (aerobic and combined) are effective in improving functional capacity and QoL perception of elderly women. Although non-periodized physical activities seem to be sufficient to positively modify the functional capacity of this population, they are not efficient in improving QoL perception. Copyright © 2018 Elsevier Inc. All rights reserved.

Stimulus Control, Transfer and Maintenance of Upright Walking Posture with a Severely Retarded Adult.

ERIC Educational Resources Information Center

Horner, Robert H.

Upright walking posture was successfully trained, maintained, and transferred to a new setting in a 28-year-old profoundly retarded adult. An apparatus in the S's cap and vest provided reinforcement (radio) when the S's head was up. The first four phases of the study demonstrated stimulus control in the training setting, while the next nine phases…

Does robot-assisted gait training ameliorate gait abnormalities in multiple sclerosis? A pilot randomized-control trial.

PubMed

Straudi, S; Benedetti, M G; Venturini, E; Manca, M; Foti, C; Basaglia, N

2013-01-01

Gait disorders are common in multiple sclerosis (MS) and lead to a progressive reduction of function and quality of life. Test the effects of robot-assisted gait rehabilitation in MS subjects through a pilot randomized-controlled study. We enrolled MS subjects with Expanded Disability Status Scale scores within 4.5-6.5. The experimental group received 12 robot-assisted gait training sessions over 6 weeks. The control group received the same amount of conventional physiotherapy. Outcomes measures were both biomechanical assessment of gait, including kinematics and spatio-temporal parameters, and clinical test of walking endurance (six-minute walk test) and mobility (Up and Go Test). 16 subjects (n = 8 experimental group, n = 8 control group) were included in the final analysis. At baseline the two groups were similar in all variables, except for step length. Data showed walking endurance, as well as spatio-temporal gait parameters improvements after robot-assisted gait training. Pelvic antiversion and reduced hip extension during terminal stance ameliorated after aforementioned intervention. Robot-assisted gait training seems to be effective in increasing walking competency in MS subjects. Moreover, it could be helpful in restoring the kinematic of the hip and pelvis.

Improved gait after repetitive locomotor training in children with cerebral palsy.

PubMed

Smania, Nicola; Bonetti, Paola; Gandolfi, Marialuisa; Cosentino, Alessandro; Waldner, Andreas; Hesse, Stefan; Werner, Cordula; Bisoffi, Giulia; Geroin, Christian; Munari, Daniele

2011-02-01

The aim of this study was to evaluate the effectiveness of repetitive locomotor training with an electromechanical gait trainer in children with cerebral palsy. In this randomized controlled trial, 18 ambulatory children with diplegic or tetraplegic cerebral palsy were randomly assigned to an experimental group or a control group. The experimental group received 30 mins of repetitive locomotor training with an applied technology (Gait Trainer GT I) plus 10 mins of passive joint mobilization and stretching exercises. The control group received 40 mins of conventional physiotherapy. Each subject underwent a total of 10 treatment sessions over a 2-wk period. Performance on the 10-m walk test, 6-min walk test, WeeFIM scale, and gait analysis was evaluated by a blinded rater before and after treatment and at 1-mo follow-up. The experimental group showed significant posttreatment improvement on the 10-m walk test, 6-min walk test, hip kinematics, gait speed, and step length, all of which were maintained at the 1-mo follow-up assessment. No significant changes in performance parameters were observed in the control group. Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity, endurance, spatiotemporal, and kinematic gait parameters in patients with cerebral palsy.

Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait.

PubMed

Kwakkel, Gert; Wagenaar, Robert C

2002-05-01

The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.

Clinical relevance of gait research applied to clinical trials in spinal cord injury.

PubMed

Ditunno, John; Scivoletto, Giorgio

2009-01-15

The restoration of walking function following SCI is extremely important to consumers and has stimulated a response of new treatments by scientists, the pharmaceutical industry and clinical entrepreneurs. Several of the proposed interventions: (1) the use of functional electrical stimulation (FES) and (2) locomotor training have been examined in clinical trials and recent reviews of the scientific literature. Each of these interventions is based on research of human locomotion. Therefore, the systematic study of walking function and gait in normal individuals and those with injury to the spinal cord has contributed to the identification of the impairments of walking, the development of new treatments and how they will be measured to determine effectiveness. In this context gait research applied to interventions to improve walking function is of high clinical relevance. This research helps identify walking impairments to be corrected and measures of walking function to be utilized as endpoints for clinical trials. The most common impairments following SCI diagnosed by observational gait analysis include inadequate hip extension during stance, persistent plantar flexion and hip/knee flexion during swing and foot placement at heel strike. FES has been employed as one strategy for correcting these impairments based on analysis that range from simple measures of speed, cadence and stride length to more sophisticated systems of three- dimensional video motion analysis and multichannel EMG tracings of integrated walking. A recent review of the entire FES literature identified 36 studies that merit comment and the full range of outcome measures for walking function were used from simple velocity to the video analysis of motion. In addition to measures of walking function developed for FES interventions, the first randomized multicenter clinical trial on locomotor training in subacute SCI was recently published with an extensive review of these measures. In this study outcome measures of motor strength (impairment), balance, Walking Index for SCI (WISCI), speed, 5min walk (walking capacities) and locomotor functional independence measure (L-FIM), a disability measure all showed improvement in walking function based on the strategy of the response of activity based plasticity to step training. Although the scientific basis for this intervention will be covered in other articles in this series, the evolution of clinical outcome measures of walking function continues to be important for the determination of effectiveness in clinical trials.

Workload comparison between hiking and indoor physical activity.

PubMed

Fattorini, Luigi; Pittiglio, Giancarlo; Federico, Bruno; Pallicca, Anastasia; Bernardi, Marco; Rodio, Angelo

2012-10-01

Walking is a physical activity able to maintain and improve aerobic fitness. This activity can easily be performed in all seasons both outdoors and indoors, but when it is performed in its natural environment, the use of specific equipment is required. In particular, it has been demonstrated that the use of trekking boots (TBs) induces a larger workload than those used indoors. Because an adequate fitness level is needed to practice hiking in safety, it is useful to know the energy demand of such an activity. This research aims at defining the metabolic engagement of hiking on natural paths with specific equipment at several speeds and comparing this with indoor ones (on a treadmill). This can thence be used to define the load that better reflects the one required to walk on natural paths. The walking energy cost (joules per kilogram per meter) at several speeds (0.28, 0.56, 0.84, 1.11, and 1.39 m·s(-1))-on level natural terrain while wearing suitable footwear (TBs) and on a treadmill at various raising slopes (0, 1, 2, 3, 4%) while wearing running shoes-was measured in 14 healthy young men (age 23.9 ± 2.9 years, stature 1.75 ± 0.04 m, and body mass 72.9 ± 6.3 kg). A physiological evaluation of all the subjects was performed before energy cost measurements. The results showed that outdoors, the oxygen uptake was consistently less than the ventilatory threshold at all speeds tested and that a 3% slope on the treadmill best reflects the outdoor walking energy expenditure. These findings will prove useful to plan proper training for hiking activity or mixed (outdoors and indoors) training program.

Feasibility of the Nintendo WiiFit™ for improving walking in individuals with a lower limb amputation

PubMed Central

Imam, Bita; McLaren, Linda; Chapman, Paul; Finlayson, Heather

2013-01-01

Objectives: To evaluate the feasibility of the Nintendo WiiFit™ as an adjunct to usual therapy in individuals with a lower limb amputation. Methods: The study was a Multiple Baseline (AB) Single Subject Research Design. Subjects were ≥19 years old, had their first unilateral transtibial or transfemoral amputation  ≤12 months ago, and were participating in prosthetic training. WiiFit training was provided for 30 min, 5 times a week, for a minimum of 2 and a maximum of 6 weeks in addition to usual therapy. Feasibility indicators were safety, post-intervention fatigue and pain levels, adherence, and subject’s acceptability of the program as measured by the Short Feedback Questionnaire–modified (SFQ-M). The primary clinical outcome was walking capacity assessed by the 2 Minute Walk Test (2MWT). The secondary clinical outcomes were the Short Physical Performance Battery, L-test, and Activities-Specific Balance Confidence. Results: Subjects (4 transtibial; 2 transfemoral) had a median age of 48.5 years (range = 45–59 years). No adverse events associated with the intervention occurred. Median pain and fatigue levels were 1.3 (range = 0.5–3.5) and 3.1 (range = 1.4–4.1), respectively. Median adherence was 80%. Subjects found the WiiFit enjoyable and acceptable (median SFQ-M = 35). Five subjects showed statistical improvement on the 2MWT and four on the secondary outcomes (p < 0.05). Conclusion: The WiiFit intervention was found to be feasible in individuals with unilateral lower limb amputation. This research provides the foundation for future clinical research investigating the use of the WiiFit as a viable adjunctive therapy to improve outcomes in individuals with unilateral lower limb amputation who are participating in prosthetic training. PMID:26770676

Feasibility of the Nintendo WiiFit™ for improving walking in individuals with a lower limb amputation.

PubMed

Imam, Bita; Miller, William C; McLaren, Linda; Chapman, Paul; Finlayson, Heather

2013-01-01

To evaluate the feasibility of the Nintendo WiiFit™ as an adjunct to usual therapy in individuals with a lower limb amputation. The study was a Multiple Baseline (AB) Single Subject Research Design. Subjects were ≥19 years old, had their first unilateral transtibial or transfemoral amputation  ≤12 months ago, and were participating in prosthetic training. WiiFit training was provided for 30 min, 5 times a week, for a minimum of 2 and a maximum of 6 weeks in addition to usual therapy. Feasibility indicators were safety, post-intervention fatigue and pain levels, adherence, and subject's acceptability of the program as measured by the Short Feedback Questionnaire-modified (SFQ-M). The primary clinical outcome was walking capacity assessed by the 2 Minute Walk Test (2MWT). The secondary clinical outcomes were the Short Physical Performance Battery, L-test, and Activities-Specific Balance Confidence. Subjects (4 transtibial; 2 transfemoral) had a median age of 48.5 years (range = 45-59 years). No adverse events associated with the intervention occurred. Median pain and fatigue levels were 1.3 (range = 0.5-3.5) and 3.1 (range = 1.4-4.1), respectively. Median adherence was 80%. Subjects found the WiiFit enjoyable and acceptable (median SFQ-M = 35). Five subjects showed statistical improvement on the 2MWT and four on the secondary outcomes (p < 0.05). The WiiFit intervention was found to be feasible in individuals with unilateral lower limb amputation. This research provides the foundation for future clinical research investigating the use of the WiiFit as a viable adjunctive therapy to improve outcomes in individuals with unilateral lower limb amputation who are participating in prosthetic training.

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.

PubMed

Mudge, Alison M; Banks, Merrilyn D; Barnett, Adrian G; Blackberry, Irene; Graves, Nicholas; Green, Theresa; Harvey, Gillian; Hubbard, Ruth E; Inouye, Sharon K; Kurrle, Sue; Lim, Kwang; McRae, Prue; Peel, Nancye M; Suna, Jessica; Young, Adrienne M

2017-01-09

Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards. Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation. ACTRN12615000879561 registered prospectively 21/8/2015.

Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.

PubMed

Gu, Yu; Dennis, Sarah M

2017-02-01

Diabetic peripheral neuropathy (DPN) is a common complication of type-2 diabetes mellitus (T2DM) that predisposes the elderly to a higher falls risk. Falls prevention programs with a component of weight-bearing exercises are effective in decreasing future falls in the elderly. However, weight-bearing exercise was only recently recommended in guidelines for exercise for people with T2DM and DPN. Since then, there have been an increasing number of studies to evaluate the effectiveness of falls prevention programs on this targeted population. A systematic literature review was undertaken to determine the effectiveness of falls prevention programs for people with T2DM and DPN. Nine published studies that investigated the effect of exercise training on falls risk among people with T2DM and DPN were included in the review. Interventions included lower limb strengthening, balance practice, aerobic exercise, walking programs, and Tai Chi. The preliminary evidence presented in this review suggests that people with T2DM and DPN can improve their balance and walking after a targeted multicomponent program without risk of serious adverse events. There is insufficient long-term follow-up data to determine whether the improvements in balance or strength resulted in a decrease falls risk in the community setting. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers.

PubMed

Ni, Meng; Mooney, Kiersten; Richards, Luca; Balachandran, Anoop; Sun, Mingwei; Harriell, Kysha; Potiaumpai, Melanie; Signorile, Joseph F

2014-09-01

To compare the effect of a custom-designed yoga program with 2 other balance training programs. Randomized controlled trial. Research laboratory. A group of older adults (N=39; mean age, 74.15 ± 6.99 y) with a history of falling. Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks. Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively. Training produced significant improvements in all field tests (P<.005), but group difference and time × group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P=.001) and eyes closed (P=.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P=.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<.01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<.001) directions were seen for the sample. Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Ten weeks of high-intensity interval walk training is associated with reduced disease activity and improved innate immune function in older adults with rheumatoid arthritis: a pilot study.

PubMed

Bartlett, David B; Willis, Leslie H; Slentz, Cris A; Hoselton, Andrew; Kelly, Leslie; Huebner, Janet L; Kraus, Virginia B; Moss, Jennifer; Muehlbauer, Michael J; Spielmann, Guillaume; Kraus, William E; Lord, Janet M; Huffman, Kim M

2018-06-14

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which adults have significant joint issues leading to poor health. Poor health is compounded by many factors, including exercise avoidance and increased risk of opportunistic infection. Exercise training can improve the health of patients with RA and potentially improve immune function; however, information on the effects of high-intensity interval training (HIIT) in RA is limited. We sought to determine whether 10 weeks of a walking-based HIIT program would be associated with health improvements as measured by disease activity and aerobic fitness. Further, we assessed whether HIIT was associated with improved immune function, specifically antimicrobial/bacterial functions of neutrophils and monocytes. Twelve physically inactive adults aged 64 ± 7 years with either seropositive or radiographically proven (bone erosions) RA completed 10 weeks of high-intensity interval walking. Training consisted of 3 × 30-minute sessions/week of ten ≥ 60-second intervals of high intensity (80-90% VO 2reserve ) separated by similar bouts of lower-intensity intervals (50-60% VO 2reserve ). Pre- and postintervention assessments included aerobic and physical function; disease activity as measured by Disease Activity score in 28 joints (DAS28), self-perceived health, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR); plasma interleukin (IL)-1β, IL-6, chemokine (C-X-C motif) ligand (CXCL)-8, IL-10, and tumor necrosis factor (TNF)-α concentrations; and neutrophil and monocyte phenotypes and functions. Despite minimal body composition change, cardiorespiratory fitness increased by 9% (change in both relative and absolute aerobic capacity; p < 0.001), and resting blood pressure and heart rate were both reduced (both p < 0.05). Postintervention disease activity was reduced by 38% (DAS28; p = 0.001) with significant reductions in ESR and swollen joints as well as improved self-perceived health. Neutrophil migration toward CXCL-8 (p = 0.003), phagocytosis of Escherichia coli (p = 0.03), and ROS production (p < 0.001) all increased following training. The frequency of cluster of differentiation 14-positive (CD14 + )/CD16 + monocytes was reduced (p = 0.002), with both nonclassical (CD14 dim /CD16 bright ) and intermediate (CD14 bright /CD16 positive ) monocytes being reduced (both p < 0.05). Following training, the cell surface expression of intermediate monocyte Toll-like receptor 2 (TLR2), TLR4, and HLA-DR was reduced (all p < 0.05), and monocyte phagocytosis of E. coli increased (p = 0.02). No changes were observed for inflammatory markers IL-1β, IL-6, CXCL-8, IL-10, CRP, or TNF-α. We report for the first time, to our knowledge, that a high-intensity interval walking protocol in older adults with stable RA is associated with reduced disease activity, improved cardiovascular fitness, and improved innate immune functions, indicative of reduced infection risk and inflammatory potential. Importantly, the exercise program was well tolerated by these patients. ClinicalTrials.gov, NCT02528344 . Registered on 19 August 2015.

Accelerometry-enabled measurement of walking performance with a robotic exoskeleton: a pilot study.

PubMed

Lonini, Luca; Shawen, Nicholas; Scanlan, Kathleen; Rymer, William Z; Kording, Konrad P; Jayaraman, Arun

2016-03-31

Clinical scores for evaluating walking skills with lower limb exoskeletons are often based on a single variable, such as distance walked or speed, even in cases where a host of features are measured. We investigated how to combine multiple features such that the resulting score has high discriminatory power, in particular with few patients. A new score is introduced that allows quantifying the walking ability of patients with spinal cord injury when using a powered exoskeleton. Four spinal cord injury patients were trained to walk over ground with the ReWalk™ exoskeleton. Body accelerations during use of the device were recorded by a wearable accelerometer and 4 features to evaluate walking skills were computed. The new score is the Gaussian naïve Bayes surprise, which evaluates patients relative to the features' distribution measured in 7 expert users of the ReWalk™. We compared our score based on all the features with a standard outcome measure, which is based on number of steps only. All 4 patients improved over the course of training, as their scores trended towards the expert users' scores. The combined score (Gaussian naïve surprise) was considerably more discriminative than the one using only walked distance (steps). At the end of training, 3 out of 4 patients were significantly different from the experts, according to the combined score (p < .001, Wilcoxon Signed-Rank Test). In contrast, all but one patient were scored as experts when number of steps was the only feature. Integrating multiple features could provide a more robust metric to measure patients' skills while they learn to walk with a robotic exoskeleton. Testing this approach with other features and more subjects remains as future work.

Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial

PubMed Central

Hollands, Kristen L.; Pelton, Trudy A.; Wimperis, Andrew; Whitham, Diane; Tan, Wei; Jowett, Sue; Sackley, Catherine M.; Wing, Alan M.; Tyson, Sarah F.; Mathias, Jonathan; Hensman, Marianne; van Vliet, Paulette M.

2015-01-01

Objectives Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke. Design This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services Participants Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments Intervention Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks. Main outcome measures: Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up. Results Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms. Conclusions Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention. Trial Registration Clinicaltrials.gov NCT01600391 PMID:26445137

Development of VariLeg, an exoskeleton with variable stiffness actuation: first results and user evaluation from the CYBATHLON 2016.

PubMed

Schrade, Stefan O; Dätwyler, Katrin; Stücheli, Marius; Studer, Kathrin; Türk, Daniel-Alexander; Meboldt, Mirko; Gassert, Roger; Lambercy, Olivier

2018-03-13

Powered exoskeletons are a promising approach to restore the ability to walk after spinal cord injury (SCI). However, current exoskeletons remain limited in their walking speed and ability to support tasks of daily living, such as stair climbing or overcoming ramps. Moreover, training progress for such advanced mobility tasks is rarely reported in literature. The work presented here aims to demonstrate the basic functionality of the VariLeg exoskeleton and its ability to enable people with motor complete SCI to perform mobility tasks of daily life. VariLeg is a novel powered lower limb exoskeleton that enables adjustments to the compliance in the leg, with the objective of improving the robustness of walking on uneven terrain. This is achieved by an actuation system with variable mechanical stiffness in the knee joint, which was validated through test bench experiments. The feasibility and usability of the exoskeleton was tested with two paraplegic users with motor complete thoracic lesions at Th4 and Th12. The users trained three times a week, in 60 min sessions over four months with the aim of participating in the CYBATHLON 2016 competition, which served as a field test for the usability of the exoskeleton. The progress on basic walking skills and on advanced mobility tasks such as incline walking and stair climbing is reported. Within this first study, the exoskeleton was used with a constant knee stiffness. Test bench evaluation of the variable stiffness actuation system demonstrate that the stiffness could be rendered with an error lower than 30 Nm/rad. During training with the exoskeleton, both users acquired proficient skills in basic balancing, walking and slalom walking. In advanced mobility tasks, such as climbing ramps and stairs, only basic (needing support) to intermediate (able to perform task independently in 25% of the attempts) skill levels were achieved. After 4 months of training, one user competed at the CYBATHLON 2016 and was able to perform 3 (stand-sit-stand, slalom and tilted path) out of 6 obstacles of the track. No adverse events occurred during the training or the competition. Demonstration of the applicability to restore ambulation for people with motor complete SCI was achieved. The CYBATHLON highlighted the importance of training and gaining experience in piloting an exoskeleton, which were just as important as the technical realization of the robot.

Functional Mobility Performance and Balance Confidence in Older Adults after Sensorimotor Adaptation Training

NASA Technical Reports Server (NTRS)

Buccello-Stout, Regina R.; Cromwell, Ronita L.; Bloomberg, Jacob J.; Weaver, G. D.

2010-01-01

Research indicates a main contributor of injury in older adults is from falling. The decline in sensory systems limits information needed to successfully maneuver through the environment. The objective of this study was to determine if prolonged exposure to the realignment of perceptual-motor systems increases adaptability of balance, and if balance confidence improves after training. A total of 16 older adults between ages 65-85 were randomized to a control group (walking on a treadmill while viewing a static visual scene) and an experimental group (walking on a treadmill while viewing a rotating visual scene). Prior to visual exposure, participants completed six trials of walking through a soft foamed obstacle course. Participants came in twice a week for 4 weeks to complete training of walking on a treadmill and viewing the visual scene for 20 minutes each session. Participants completed the obstacle course after training and four weeks later. Average time, penalty, and Activity Balance Confidence Scale scores were computed for both groups across testing times. The older adults who trained, significantly improved their time through the obstacle course F (2, 28) = 9.41, p < 0.05, as well as reduced their penalty scores F (2, 28) = 21.03, p < 0.05, compared to those who did not train. There was no difference in balance confidence scores between groups across testing times F (2, 28) = 0.503, p > 0.05. Although the training group improved mobility through the obstacle course, there were no differences between the groups in balance confidence.

An Exemplary Environmental Education Progam in Poland - Walks on the Bolimov Nature Preserve Trails

NASA Astrophysics Data System (ADS)

Dabrowska, A. E.

2013-12-01

The Regional Teacher Training Centre in Skierniewice is one of 49 public, accredited institutions in Poland carrying out it statutory goals at the regional level. It has been operating since 1989 and is responsible for organizing of support of schools, institutions, networks of teachers and school managers for cooperation and self-education, organizing and conducting various forms of in-service training, giving methodological councils and disseminating examples of good practice. I present one example of how Environmental Education has been imparted to school students and their teachers through outdoor activities as part of the learning process. An Environmental Education Program, 'On Bolimov Nature Preserve Trails' has been organized regularly since 2001. The Bolimov Nature Preserve is a protected area in central Poland, situated between two agglomerations: capital city Warsaw to the East and industrial city Lodz to the West, covering an area of 231,3 sq kilometers. It was established in 1986 to protect an unique ecosystem on the Rawka River banks from human activity and harmful external factors. Pine tree forests cover more than 60% of the landscape park. Small streams, sloughs, glades are another elements of the park scenery. Walks on the trails in this park are a great opportunity to see many unique species of flora (more than 40 protected species and many endangered species on verge of extinction) and fauna. For teachers and students the Bolimov Nature Preserve offers educational lessons and events in cooperation with other institutions e.g. Regional Teacher Training Centre in Skierniewice. The main activity of the walks is participation of students and teachers in group walk along trails of the park using various tools of orientation: maps, compasses and nowadays GPS. Along the paths they learn recognition of forms of terrain, identification of species of plants and animals (using flora & fauna guides and keys, magnifying glasses), measuring and identification of components of weather (using weather atlases, thermometers an anemometers) as well as preparation of soil profile. Some tasks are prepared by students before the event, at school and then presented as a part of competition e.g. soil profile. A survey is conducted after each such program. A statistical analysis of the survey data reveals that each year more and more students representing all levels of education from primary to upper secondary levels and their teachers are involved in this enterprise. Oral and written evaluations reveal that both students and teachers highly assess participation in this event. Each year the same schools and sometimes more are engaged in the enterprise. Students prepare to participation in event before the date it is organized through gaining knowledge about biodiversity and cultural monuments of the landscape park, preparing research on the topics announced in every year. Their abilities and knowledge are checked during the walk as well as through participation in many competitions. Each year almost 700 - 1000 students and about 100 teachers participate in this ecological learning process. Outdoor education, observations and experimentations are crucial issues of national school curricula referring to all educational levels which is successfully addressed by this program.

Computerized visual feedback: an adjunct to robotic-assisted gait training.

PubMed

Banz, Raphael; Bolliger, Marc; Colombo, Gery; Dietz, Volker; Lünenburger, Lars

2008-10-01

Robotic devices for walking rehabilitation allow new possibilities for providing performance-related information to patients during gait training. Based on motor learning principles, augmented feedback during robotic-assisted gait training might improve the rehabilitation process used to regain walking function. This report presents a method to provide visual feedback implemented in a driven gait orthosis (DGO). The purpose of the study was to compare the immediate effect on motor output in subjects during robotic-assisted gait training when they used computerized visual feedback and when they followed verbal instructions of a physical therapist. Twelve people with neurological gait disorders due to incomplete spinal cord injury participated. Subjects were instructed to walk within the DGO in 2 different conditions. They were asked to increase their motor output by following the instructions of a therapist and by observing visual feedback. In addition, the subjects' opinions about using visual feedback were investigated by a questionnaire. Computerized visual feedback and verbal instructions by the therapist were observed to result in a similar change in motor output in subjects when walking within the DGO. Subjects reported that they were more motivated and concentrated on their movements when using computerized visual feedback compared with when no form of feedback was provided. Computerized visual feedback is a valuable adjunct to robotic-assisted gait training. It represents a relevant tool to increase patients' motor output, involvement, and motivation during gait training, similar to verbal instructions by a therapist.

Effects of treadmill training on functional recovery following peripheral nerve injury in rats

PubMed Central

Boeltz, Tiffany; Ireland, Meredith; Mathis, Kristin; Nicolini, Jennifer; Poplavski, Karen; Rose, Samuel J.; Wilson, Erin

2013-01-01

Exercise, in the form of moderate daily treadmill training following nerve transection and repair leads to enhanced axon regeneration, but its effect on functional recovery is less well known. Female rats were exercised by walking continuously, at a slow speed (10 m/min), for 1 h/day on a level treadmill, beginning 3 days after unilateral transection and surgical repair of the sciatic nerve, and conducted 5 days/wk for 2 wk. In Trained rats, both direct muscle responses to tibial nerve stimulation and H reflexes in soleus reappeared earlier and increased in amplitude more rapidly over time than in Untrained rats. The efficacy of the restored H reflex was greater in Trained rats than in Untrained controls. The reinnervated tibialis anterior and soleus were coactivated during treadmill locomotion in Untrained rats. In Trained animals, the pattern of activation of soleus, but not tibialis anterior, was not significantly different from that found in Intact rats. The overall length of the hindlimb during level and up- and downslope locomotion was conserved after nerve injury in both groups. This conservation was achieved by changes in limb orientation. Limb length was conserved effectively in all rats during downslope walking but only in Trained rats during level and upslope walking. Moderate daily exercise applied immediately after sciatic nerve transection is sufficient to promote axon regeneration, to restore muscle reflexes, and to improve the ability of rats to cope with different biomechanical demands of slope walking. PMID:23468390

Exercise Habit

MedlinePlus

... and lungs. Examples of aerobic exercise include walking, hiking, running, aerobic dance, biking, rowing, swimming, and cross- ... Examples of weight-bearing exercise include walking, yoga, hiking, climbing stairs, playing tennis, dancing, and strength training. ...

Walk Test Used to Monitor the Performance in the Health-Directed Nordic Walking

ERIC Educational Resources Information Center

Kamien, Dorota

2008-01-01

Study aim: To assess the performance of subjects engaged in health-directed Nordic Walking training (with poles) and subjected to 2-km walk test (no poles). Material and methods: A total of 72 subjects, including 8 men and 32 women aged 23-73 years and 32 female students aged 19-25 years participated in the study. They were subjected twice to 2-km…

Short-burst interval treadmill training walking capacity and performance in cerebral palsy: a pilot study.

PubMed

Bjornson, Kristie F; Moreau, Noelle; Bodkin, Amy Winter

2018-04-16

To examine the effect of short-burst interval locomotor treadmill training (SBLTT) on walking capacity and performance in cerebral palsy (CP). Twelve children with spastic diplegic CP (average 8.6 years) across Gross Motor Function Classification System levels II (8) and III (4) were randomized to 20 SBLTT sessions over 4 or 10 weeks. SBLTT consisted of alternating 30 seconds of slow and fast walking for 30 minutes/session. Outcomes included the 10 m walk test, one-minute walk test (1MWT), and timed-up-and go (TUG) (capacity) and StepWatch (performance) collected at baseline, post, and 6 weeks post. Fast speed (+.11, p = .04; +.11 m/s, p = .006), 1MWT (+11.2; +11.7 m, p = .006) and TUG (-1.7; -1.9 seconds, p = .006) improved post SBLTT and 6 weeks, respectively. Walking performance increased: average strides/day (+948; +1712, p < .001) and percent time in high strides rates (+0.4, p = 0.07; +0.2, p = .008). Pilot study suggests SBLTT may improve short-term walking capacity and performance.

Visual feedback training using WII Fit improves balance in Parkinson's disease.

PubMed

Zalecki, Tomasz; Gorecka-Mazur, Agnieszka; Pietraszko, Wojciech; Surowka, Artur D; Novak, Pawel; Moskala, Marek; Krygowska-Wajs, Anna

2013-01-01

Postural instability including imbalance is the most disabling long term problem in Parkinson's disease (PD) that does not respond to pharmacotherapy. This study aimed at investigating the effectiveness of a novel visual-feedback training method, using Wii Fit balance board in improving balance in patients with PD. Twenty four patients with moderate PD were included in the study which comprised of a 6-week home-based balance training program using Nintendo Wii Fit and balance board. The PD patients significantly improved their results in Berg Balance Scale, Tinnet's Performance-Oriented Mobility Assessment, Timed Up-and-Go, Sit-to-stand test, 10-Meter Walk test and Activities-specific Balance Confidence scale at the end of the programme. This study suggests that visual feedback training using Wii-Fit with balance board could improve dynamic and functional balance as well as motor disability in PD patients.

A randomized clinical trial to assess the influence of a three months training program (gym-based individualized vs. calisthenics-based non-invidualized) in COPD-patients.

PubMed

Greulich, Timm; Kehr, Katharina; Nell, Christoph; Koepke, Janine; Haid, Daniel; Koehler, Ulrich; Koehler, Kay; Filipovic, Silke; Kenn, Klaus; Vogelmeier, Claus; Koczulla, Andreas-Rembert

2014-03-25

Pulmonary rehabilitation has been demonstrated to improve exercise capacity, dyspnoea, quality of life and to reduce the adverse effects of acute exacerbations. Current guidelines recommend exercise training in patients with mild to very severe disease. However, there is insufficient data comparing the efficacy of different training approaches and intensities. Between January 2009 and December 2012, 105 COPD patients were screened to participate in the study. 61 patients were randomly assigned into an individualized training group or into a non-individualized training group. Both groups exercised once a week for 60 minutes over a time period of three months. At the beginning and after three months, the following measurements were performed: 6-minute walking test (6-MWT), health-related quality of life (St. Georges Respiratory Questionnaire; SGRQ and COPD-Assessment-Test; CAT), M. rectus femoris cross-sectional area, and inflammatory markers in peripheral blood. Only in the individualized training group we observed a significant change of the 6-MWT (increase of 32.47 m; p = 0.012) and the cross-sectional area of the M. rectus fermoris (increase of 0.57 cm2; p = 0.049), while no significant changes occurred in the non-individualized training group. Peroxisome-proliferator-activated receptor-γ coactivator 1α increased in the individualized training only after the three months training period (increase of 0.43 relative copies; p = 0.017), all other myokines and inflammatory markers were not influenced by either of the programs. The total drop-out-rate was 44.3%. A low frequency outpatient training program may induce modest improvements in exercise capacity and muscle mass only if it is performed on an individualized basis.

A randomized clinical trial to assess the influence of a three months training program (Gym-based individualized vs. Calisthenics-based non-invidualized) in COPD-patients

PubMed Central

2014-01-01

Introduction Pulmonary rehabilitation has been demonstrated to improve exercise capacity, dyspnoea, quality of life and to reduce the adverse effects of acute exacerbations. Current guidelines recommend exercise training in patients with mild to very severe disease. However, there is insufficient data comparing the efficacy of different training approaches and intensities. Methods Between January 2009 and December 2012, 105 COPD patients were screened to participate in the study. 61 patients were randomly assigned into an individualized training group or into a non-individualized training group. Both groups exercised once a week for 60 minutes over a time period of three months. At the beginning and after three months, the following measurements were performed: 6-minute walking test (6-MWT), health-related quality of life (St. Georges Respiratory Questionnaire; SGRQ and COPD-Assessment-Test; CAT), M. rectus femoris cross-sectional area, and inflammatory markers in peripheral blood. Results Only in the individualized training group we observed a significant change of the 6-MWT (increase of 32.47 m; p = 0.012) and the cross-sectional area of the M. rectus fermoris (increase of 0.57 cm2; p = 0.049), while no significant changes occurred in the non-individualized training group. Peroxisome-proliferator-activated receptor-γ coactivator 1α increased in the individualized training only after the three months training period (increase of 0.43 relative copies; p = 0.017), all other myokines and inflammatory markers were not influenced by either of the programs. The total drop-out-rate was 44.3%. Conclusion A low frequency outpatient training program may induce modest improvements in exercise capacity and muscle mass only if it is performed on an individualized basis. PMID:24666558

Robot-Assisted Body-Weight-Supported Treadmill Training in Gait Impairment in Multiple Sclerosis Patients: A Pilot Study.

PubMed

Łyp, Marek; Stanisławska, Iwona; Witek, Bożena; Olszewska-Żaczek, Ewelina; Czarny-Działak, Małgorzata; Kaczor, Ryszard

2018-02-13

This study deals with the use of a robot-assisted body-weight-supported treadmill training in multiple sclerosis (MS) patients with gait dysfunction. Twenty MS patients (10 men and 10 women) of the mean of 46.3 ± 8.5 years were assigned to a six-week-long training period with the use of robot-assisted treadmill training of increasing intensity of the Lokomat type. The outcome measure consisted of the difference in motion-dependent torque of lower extremity joint muscles after training compared with baseline before training. We found that the training uniformly and significantly augmented the torque of both extensors and flexors of the hip and knee joints. The muscle power in the lower limbs of SM patients was improved, leading to corrective changes of disordered walking movements, which enabled the patients to walk with less effort and less assistance of care givers. The torque augmentation could have its role in affecting the function of the lower extremity muscle groups during walking. The results of this pilot study suggest that the robot-assisted body-weight-supported treadmill training may be a potential adjunct measure in the rehabilitation paradigm of 'gait reeducation' in peripheral neuropathies.

Validation of Walking Trails for the Urban TrainingTM of Chronic Obstructive Pulmonary Disease Patients

PubMed Central

Arbillaga-Etxarri, Ane; Torrent-Pallicer, Jaume; Gimeno-Santos, Elena; Barberan-Garcia, Anael; Delgado, Anna; Balcells, Eva; Rodríguez, Diego A.; Vilaró, Jordi; Vall-Casas, Pere; Irurtia, Alfredo; Rodriguez-Roisin, Robert; Garcia-Aymerich, Judith

2016-01-01

Purpose Accessible interventions to train patients with chronic obstructive pulmonary disease (COPD) are needed. We designed urban trails of different intensities (low, moderate and high) in different types of public spaces (boulevard, beach and park). We aimed to validate the trails’ design by assessing the physiological response to unsupervised walking trails of: (1) different intensities in COPD patients, and (2) same intensity from different public spaces in healthy adults. Methods On different days and under standardized conditions, 10 COPD patients walked the three intensity trails designed in a boulevard space, and 10 healthy subjects walked the three intensity trails in three different spaces. We measured physiological response and energy expenditure using a gas analyzer. We compared outcomes across trails intensity and/or spaces using mixed-effects linear regression. Results In COPD patients, physiological response and energy expenditure increased significantly according to the trails intensity: mean (SD) peak V˙O2 15.9 (3.5), 17.4 (4.7), and 17.7 (4.4) mL/min/kg (p-trend = 0.02), and MET-min 60 (23), 64 (26), 72 (31) (p-trend<0.01) in low, moderate and high intensity trails, respectively. In healthy subjects there were no differences in physiological response to walking trails of the same intensity across different spaces. Conclusions We validated the trails design for the training of COPD patients by showing that the physiological response to and energy expenditure on unsupervised walking these trails increased according to the predefined trails’ intensity and did not change across trails of the same intensity in different public space. Walkable public spaces allow the design of trails that could be used for the training of COPD patients in the community. PMID:26766184

Towards the integration of mental practice in rehabilitation programs. A critical review

PubMed Central

Malouin, Francine; Jackson, Philip L.; Richards, Carol L.

2013-01-01

Many clinical studies have investigated the use of mental practice (MP) through motor imagery (MI) to enhance functional recovery of patients with diverse physical disabilities. Although beneficial effects have been generally reported for training motor functions in persons with chronic stroke (e.g., reaching, writing, walking), attempts to integrate MP within rehabilitation programs have been met with mitigated results. These findings have stirred further questioning about the value of MP in neurological rehabilitation. In fact, despite abundant systematic reviews, which customarily focused on the methodological merits of selected studies, several questions about factors underlying observed effects remain to be addressed. This review discusses these issues in an attempt to identify factors likely to hamper the integration of MP within rehabilitation programs. First, the rationale underlying the use of MP for training motor function is briefly reviewed. Second, three modes of MI delivery are proposed based on the analysis of the research protocols from 27 studies in persons with stroke and Parkinson's disease. Third, for each mode of MI delivery, a general description of MI training is provided. Fourth, the review discusses factors influencing MI training outcomes such as: the adherence to MI training, the amount of training and the interaction between physical and mental rehearsal; the use of relaxation, the selection of reliable, valid and sensitive outcome measures, the heterogeneity of the patient groups, the selection of patients and the mental rehearsal procedures. To conclude, the review proposes a framework for integrating MP in rehabilitation programs and suggests research targets for steering the implementation of MP in the early stages of the rehabilitation process. The challenge has now shifted towards the demonstration that MI training can enhance the effects of regular therapy in persons with subacute stroke during the period of spontaneous recovery. PMID:24065903

Neuromuscular training based on whole body vibration in children with spina bifida: a retrospective analysis of a new physiotherapy treatment program.

PubMed

Stark, C; Hoyer-Kuhn, H-K; Semler, O; Hoebing, L; Duran, I; Cremer, R; Schoenau, E

2015-02-01

Spina bifida is the most common congenital cause of spinal cord lesions resulting in paralysis and secondary conditions like osteoporosis due to immobilization. Physiotherapy is performed for optimizing muscle function and prevention of secondary conditions. Therefore, training of the musculoskeletal system is one of the major aims in the rehabilitation of children with spinal cord lesions. The neuromuscular physiotherapy treatment program Auf die Beine combines 6 months of home-based whole body vibration (WBV) with interval blocks at the rehabilitation center: 13 days of intensive therapy at the beginning and 6 days after 3 months. Measurements are taken at the beginning (M0), after 6 months of training (M6), and after a 6-month follow-up period (M12). Gait parameters are assessed by ground reaction force and motor function by the Gross Motor Function Measurement (GMFM-66). Sixty children (mean age 8.71 ± 4.7 years) who participated in the program until February 2014 were retrospectively analyzed. Walking velocity improved significantly by 0.11 m/s (p = 0.0026) and mobility (GMFM-66) by 2.54 points (p = 0.001) after the training. All changes at follow-up were not significant, but significant changes were observed after the training period. Decreased contractures were observed with increased muscle function. Significant improvements in motor function were observed after the active training period of the new neuromuscular training concept. This first analysis of the new neuromuscular rehabilitation concept Auf die Beine showed encouraging results for a safe and efficient physiotherapy treatment program which increases motor function in children with spina bifida.

Gait Evaluation of Overground Walking and Treadmill Walking Using Compass-Type Walking Model

NASA Astrophysics Data System (ADS)

Nagata, Yousuke; Yamamoto, Masayoshi; Funabiki, Shigeyuki

A treadmill is a useful apparatus for the gait training and evaluation. However, many differences are reported between treadmill and overground walking. Experimental comparisons of the muscle activity of the leg and the heart rate have been carried out. However, the dynamic comparison has not been performed. The dynamic evaluation of the overground walking and the treadmill walking using a compass-type walking model (CTWM) which is a simple bipedal walking model, then their comparison is discussed. It is confirmed that the walking simulation using the CTWM can simulate the difference of that walk, it is clarified that there are the differences of the kick impulse on the ground and the turning impulse of the foot to the variation of the belt speed and then differences are the main factor of two walking.

[Effect of "Xingnao Kaiqiao Zhenfa" (Acupuncture Technique for Restoring Consciousness) Combined with Rehabilitation Training on Nerve Repair and Expression of Growth-associated Protein-43 of Peri-ischemic Cortex in Ischemic Stroke Rats].

PubMed

Xu, Lei; Yan, Xing-Zhou; Li, Zhen-Yu; Cao, Xiao-Fang; Wang, Min

2017-06-25

To observe the effect of "Xingnao Kaiqiao Zhenfa" (acupuncture technique for restoring consciousness) combined with enriched rehabilitation training on motor function and expression of growth-associated protein-43 (GAP-43) of peri-ischemic cortex in ischemic stroke rats, so as to investigate its mechanism underlying improvement of ischemic stroke. SD rats were randomly divided into sham operation, model, rehabilitation and comprehensive rehabilitation groups, which were further divided into 3 time-points:7, 14 and 21 d ( n =6 in each). Cerebral ischemia(CI) model was established by occlusion of the middle cerebral artery with heat-coagulation. The rehabilitation group was treated by enriched rehabilitation training, once a day. The comprehensive rehabilitation group was treated by acupuncture combined with enriched rehabilitation training. Acupuncture was applied to bilateral "Neiguan"(PC 6) and "Shuigou"(GV 26) for 30 min, once a day. The neurological function score, balance-beam walking test and rotating-rod walking test were evaluated at the end of the corresponding treatment time. The expression of GAP-43 in peri-ischemic cortex was detected by immunohistochemistry. In comparison with the sham operation group, the scores of neurological function, beam walking test and rotating-rod walking test were significantly higher in the model group ( P <0.01). There were no significant changes in the scores of balance-beam walking and rotating-rod walking tests in the rehabilitation group compared with the model group on day 7 ( P >0.05). Compared with the model group at the other time points, the scores of neurological function, balance-beam walking test and rotating-rod walking test were significantly lower in the rehabilitation and comprehensive rehabilitation groups ( P <0.05). Compared with the rehabilitation group, the scores of neurological function, balance-beam walking test and rotating-rod walking test were significantly lower in the comprehensive rehabilitation group ( P <0.05). In comparison with the sham operation group, the number of GAP-43 positive cells of peri-ischemic cortex was significantly higher in the model group ( P <0.01). Compared with the model group, the numbers of GAP-43 positive cells of peri-ischemic cortex were significantly increased in the rehabilitation and comprehensive rehabilitation groups ( P <0.01). The number of GAP-43 positive cells of peri-ischemic cortex in the comprehensive rehabilitation group was significantly higher than that in the rehabilitation group ( P <0.01). "Xingnao Kaiqiao Zhenfa" combined with enriched rehabilitation training can promote the recovery of nerve function in ischemic stroke rats, which may be associated with its effect in up-regulating the expression of GAP-43 in the peri-ischemic cortex.

Establishing Walking Responses in a Twenty-Month Old Child by a Parent Trained in Behavioral Analysis.

ERIC Educational Resources Information Center

Angney, Alice

Walking behavior was established in a 20-month-old Down's Syndrome girl by a parent trained in behavior analysis. During a series of 7-minute sessions, the child was given edible reinforcement for taking unsupported steps between two chairs which were gradually moved from 18 to 70 inches apart. In three final generalization sessions, the chairs…

Fixed-distance walk tests at comfortable and fast speed: Potential tools for the functional assessment of coronary patients?

PubMed

Morard, Marie-Doriane; Besson, Delphine; Laroche, Davy; Naaïm, Alexandre; Gremeaux, Vincent; Casillas, Jean-Marie

2017-01-01

There is ambiguity concerning the walk tests available for functional assessment of coronary patients, particularly for the walking speed. This study explores the psychometric properties of two walking tests, based on fixed-distance tests, at comfortable and fast velocity, in stabilized patients at the end of a cardiac rehabilitation program. At a three-day interval 58 coronary patients (mean age of 64.85±6.03 years, 50 men) performed three walk tests, the first two at a comfortable speed in a random order (6-minute walk test - 6MWT - and 400-metre comfortable walk test - 400mCWT) and the third at a brisk speed (200-metre fast walk test - 200mFWT). A modified Bruce treadmill test was associated at the end of the second phase. Monitored main parameters were: heart rate, walking velocity, VO 2 . Tolerance to the 3 tests was satisfactory. The reliability of the main parameters was good (intraclass correlation coefficient>0.8). The VO 2 concerning 6MWT and 400mCWT were not significantly different (P=0.33) and were lower to the first ventilatory threshold determined by the stress test (P<0.001): 16.2±3.0 vs. 16.5±2.6 vs. 20.7±5.1mL·min -1 ·kg -1 respectively. The VO 2 of the 200mFWT (20.2±3.7) was not different from the first ventilatory threshold. 400mCWT and 200mFWT are feasible, well-tolerated and reliable. They explore two levels of effort intensity (lower and not different to the first ventilatory threshold respectively). 400mCWT is a possible alternative to 6MWT. Associated with 200mFWT it should allow a better measurement of physical capacities and better customization of exercise training. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Effect of Body Weight-supported Walking on Exercise Capacity and Walking Speed in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

PubMed Central

Someya, Fujiko

2013-01-01

Abstract Objective: To compare the effect of body-weight-supported treadmill training (BWSTT) and full-body-weight treadmill training (FBWTT) on patients with knee osteoarthritis (OA). Methods: Design was Randomized controlled trial. Patients with knee osteoarthritis (n = 30; mean age, 76.0±7.5 y) were randomly assigned to BWSTT or FBWTT group. All patients performed 20 min walking exercise twice a week for 6 weeks under the supervision of the therapist. Main measures were 10-meter walking test (10MWT), functional reach test (FRT), timed get up and go test (TUG), one-leg standing test, 6-minute walking test (6MWT), the parameters set on the treadmill, MOS Short-Form 36-Item Health Survey (SF36), Japanese Knee Osteoarthritis Measure (JKOM). Results: Twenty-five patients (10 men, 15 women; mean age, 76.5 ± 8.0 y) completed the experiment. Exercise capacity, indicated by the heart rate, was similar in both groups. After 3 weeks of BWSTT, the patients performed significantly better in the 10-m and 6-min walking tests. This was not the case with FBWTT even after 6 weeks training. Pain levels assessed were significantly improved after 3 weeks of BWSTT and 6 weeks of FBWTT. There were no significant improvements in either group assessed by the FRT, one-leg standing time test, TUG, or SF -36 questionnaire. Conclusions: BWSTT enhanced exercise capacity in terms of walking speed and pain reduction after 3 weeks; however, there was no significant improvement in patients' functional abilities or quality of life. PMID:25792901

Locomotor training and virtual reality-based balance training for an individual with multiple sclerosis: a case report.

PubMed

Fulk, George D

2005-03-01

Impaired walking ability, balance, and fatigue are common problems for people with multiple sclerosis (MS). The purpose of this case report is to describe the use of plan of care that included locomotor training using both a body weight support (BWS) with a treadmill (TM) and overground walking as well as a virtual reality (VR)-based balance intervention to improve walking ability, balance, and endurance for an individual with MS. The client was a 48-year-old female with a 10-year history of MS. Her main goals were to improve walking ability, balance, and endurance. She presented with impaired gait, balance, motor function, and increased fatigue. Locomotor training using a BWS/TM system and overground and VR-based balance interventions were implemented 2 days a week for 12 weeks. The client demonstrated improvements in gait speed, gait endurance, and balance postintervention and maintained the improvements at a 2-month follow up. This case report is the first to report on the use of locomotor training with BWS/TM system and overground and VR-based balance interventions for a client with MS. The plan of care was formulated based on the patient's goals and the available literature on the use of the interventions with other patients with neurologic conditions to provide an intervention that was task-oriented, skilled, and intensive.

Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support.

PubMed

Hesse, S; Uhlenbrock, D; Sarkodie-Gyan, T

1999-10-01

To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Motion analysis laboratory of a rehabilitation centre. Fourteen chronic, nonambulatory hemiparetic patients. Complex gait analysis while training on the gait trainer and while walking on the treadmill. Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking (p <0.01). The pattern and amount of activation of relevant weight-bearing muscles was comparable with an even larger activation of the M. biceps femoris on the gait trainer (p <0.01). The tibialis anterior muscle of the nonaffected side, however, was less activated during swing (p <0.01). Two therapists assisted walking on the treadmill while only one therapist was necessary to help with weight shifting on the new device. The newly developed gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.

Changes in dual-task performance after 5 months of karate and fitness training for older adults to enhance fall prevention.

PubMed

Pliske, Gerald; Emmermacher, Peter; Weinbeer, Veronika; Witte, Kerstin

2016-12-01

Demographic changes resulting in an aging population are major factors for an increase of fall-related injuries. Especially in situations where dual tasks such as walking whilst talking have to be performed simultaneously the risk of a fall-related injury increases. It is well known that some types of martial art (e.g. Tai Chi) can reduce the risk of a fall. It is unknown if the same is true for karate. In this randomized, controlled study 68 people with a mean age of 69 years underwent 5-month karate training, 5-month fitness training or were part of a control group. Before and after the time of intervention a gait analysis with normal walk, a cognitive dual task and a motor dual task were performed. The gait parameter step frequency, walking speed, single-step time and single-step length were investigated. It could be seen that all groups improved their gait parameters after a 5-month period, even the control group. A sporty intervention seems to affect mainly the temporal gait parameters positively. This effect was especially demonstrated for normal walk and cognitive dual task. An improvement of the human walk seems to be possible through karate and fitness training, even under dual-task conditions. A prolonged intervention time with multiple repetitions of gait analysis could give better evidence if karate is a useful tool to increase fall prevention.

Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery.

PubMed

Mayo, Nancy E; Feldman, Liane; Scott, Susan; Zavorsky, Gerald; Kim, Do Jun; Charlebois, Patrick; Stein, Barry; Carli, Francesco

2011-09-01

Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished. "Prehabilitation" is a program to increase functional capacity in anticipation of an upcoming stressor. We reported recently the results of a randomized trial comparing 2 prehabilitation programs before colorectal surgery (stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises); however, adherence to the programs was low. The objectives of this study were to estimate: (1) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response; and (2) the impact of change in preoperative function on postoperative recovery. This study involved a reanalysis of data arising from a randomized trial. The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test; secondary outcomes were anxiety, depression, health-related quality of life, and complications (Clavien classification). Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods. We included 95 people who completed the prehabilitation phase (median, 38 days; interquartile range, 22-60), and 75 who were also evaluated postoperatively (mean, 9 weeks). During prehabilitation, 33% improved their physical function, 38% stayed within 20 m of their baseline score, and 29% deteriorated. Among those who improved, mental health, vitality, self-perceived health, and peak exercise capacity also increased significantly. Women were less likely to improve; low baseline walking capacity, anxiety, and the belief that fitness aids recovery were associated with improvements during prehabilitation. In the postoperative phase, the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration (77% vs 59% and 32%; P = .0007). Patients who deteriorated were at greater risk of complications requiring reoperation and/or intensive care management. Significant predictors of poorer recovery included deterioration during prehabilitation, age >75 years, high anxiety, complications requiring intervention, and timing of follow-up assessment. In a group of patients undergoing scheduled colorectal surgery, meaningful changes in functional capacity can be achieved over several weeks of prehabilitation. Patients and those who care for them, especially those with poor physical capacity, should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy. Copyright © 2011 Mosby, Inc. All rights reserved.

A home-based body weight supported treadmill training program for children with cerebral palsy: A case series.

PubMed

Kenyon, Lisa K; Westman, Marci; Hefferan, Ashley; McCrary, Peter; Baker, Barbara J

2017-07-01

Contemporary approaches to the treatment of cerebral palsy (CP) advocate a task-specific approach that emphasizes repetition and practice of specific tasks. Recent studies suggest that body-weight-supported treadmill training (BWSTT) programs may be beneficial in clinical settings. The purposes of this case series were to explore the outcomes and feasibility of a home-based BWSTT program for three children with CP. Three children with CP at Gross Motor Function Classification System (GMFCS) Levels III or IV participated in this case series. Examination included the Functional Assessment Questionnaire (FAQ), the 10-meter walk test, the Gross Motor Function Measure (GMFM-66), and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). A harness system was used to conduct the BWSTT program over an 8-12 week period. All of the families reported enjoying the BWSTT program and found the harness easy to use. Participant 2 increased from a 2 to a 4 on the FAQ, while Participant 3 increased from a 6 to a 7. Two of the participants demonstrated post-intervention improvements in functional mobility. In addition to mobility outcomes, future research should explore the potential health benefits of a home-based BWSTT program.

Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up.

PubMed

Waller, B; Munukka, M; Rantalainen, T; Lammentausta, E; Nieminen, M T; Kiviranta, I; Kautiainen, H; Häkkinen, A; Kujala, U M; Heinonen, A

2017-08-01

To investigate the effects of 4-months intensive aquatic resistance training on body composition and walking speed in post-menopausal women with mild knee osteoarthritis (OA), immediately after intervention and after 12-months follow-up. Additionally, influence of leisure time physical activity (LTPA) will be investigated. This randomised clinical trial assigned eighty-seven volunteer postmenopausal women into two study arms. The intervention group (n = 43) participated in 48 supervised intensive aquatic resistance training sessions over 4-months while the control group (n = 44) maintained normal physical activity. Eighty four participants continued into the 12-months' follow-up period. Body composition was measured with dual-energy X-ray absorptiometry (DXA). Walking speed over 2 km and the knee injury and osteoarthritis outcome score (KOOS) were measured. LTPA was recorded with self-reported diaries. After the 4-month intervention there was a significant decrease (P = 0.002) in fat mass (mean change: -1.17 kg; 95% CI: -2.00 to -0.43) and increase (P = 0.002) in walking speed (0.052 m/s; 95% CI: 0.018 to 0.086) in favour of the intervention group. Body composition returned to baseline after 12-months. In contrast, increased walking speed was maintained (0.046 m/s; 95% CI 0.006 to 0.086, P = 0.032). No change was seen in lean mass or KOOS. Daily LTPA over the 16-months had a significant effect (P = 0.007) on fat mass loss (f 2  = 0.05) but no effect on walking speed. Our findings show that high intensity aquatic resistance training decreases fat mass and improves walking speed in post-menopausal women with mild knee OA. Only improvements in walking speed were maintained at 12-months follow-up. Higher levels of LTPA were associated with fat mass loss. ISRCTN65346593. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Lower extremity kinematics during walking and elliptical training in individuals with and without traumatic brain injury.

PubMed

Buster, Thad; Burnfield, Judith; Taylor, Adam P; Stergiou, Nicholas

2013-12-01

Elliptical training may be an option for practicing walking-like activity for individuals with traumatic brain injuries (TBI). Understanding similarities and differences between participants with TBI and neurologically healthy individuals during elliptical trainer use and walking may help guide clinical applications incorporating elliptical trainers. Ten participants with TBI and a comparison group of 10 neurologically healthy participants underwent 2 familiarization sessions and 1 data collection session. Kinematic data were collected as participants walked on a treadmill or on an elliptical trainer. Gait-related measures, including coefficient of multiple correlations (a measure of similarity between ensemble joint movement profiles; coefficient of multiple correlations [CMCs]), critical event joint angles, variability of peak critical event joint angles (standard deviations [SDs]) of peak critical event joint angles, and maximum Lyapunov exponents (a measure of the organization of the variability [LyEs]) were compared between groups and conditions. Coefficient of multiple correlations values comparing the similarity in ensemble motion profiles between the TBI and comparison participants exceeded 0.85 for the hip, knee, and ankle joints. The only critical event joint angle that differed significantly between participants with TBI and comparison participants was the ankle during terminal stance. Variability was higher for the TBI group (6 of 11 comparisons significant) compared with comparison participants. Hip and knee joint movement patterns of both participants with TBI and comparison participants on the elliptical trainer were similar to walking (CMCs ≥ 0.87). Variability was higher during elliptical trainer usage compared with walking (5 of 11 comparisons significant). Hip LyEs were higher during treadmill walking. Ankle LyEs were greater during elliptical trainer usage. Movement patterns of participants with TBI were similar to, but more variable than, those of comparison participants while using both the treadmill and the elliptical trainer. If incorporation of complex movements similar to walking is a goal of rehabilitation, elliptical training is a reasonable alternative to treadmill-based training.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A65) for more insights from the authors.

Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study.

PubMed

Yang, Mingliang; Li, Jianjun; Guan, Xinyu; Gao, Lianjun; Gao, Feng; Du, Liangjie; Zhao, Hongmei; Yang, Degang; Yu, Yan; Wang, Qimin; Wang, Rencheng; Ji, Linhong

2017-09-01

The high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia. The cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session. Compared to the RGO, the HESWO increased continuous walking distance by 24.7% (P<0.05), maximum walking speed by 20.4% (P<0.05) and the comfortable walking speed by 15.3% (P<0.05), as well as decreasing energy expenditure by 13.9% (P<0.05). Our preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking. Copyright © 2017. Published by Elsevier B.V.

D.U.C.K. Walking.

ERIC Educational Resources Information Center

Steller, Jenifer J.

This manual presents a schoolwide walking program that includes aerobic fitness information, curriculum integration, and walking tours. "Discover and Understand Carolina Kids by Walking" is D.U.C.K. Walking. An aerobic walking activity, D.U.C.K. Walking has two major goals: (1) to promote regular walking as a way to exercise at any age;…

Changes in balance, functional performance and fall risk following whole body vibration training and vitamin D supplementation in institutionalized elderly women. A 6 month randomized controlled trial.

PubMed

Bogaerts, An; Delecluse, Christophe; Boonen, Steven; Claessens, Albrecht L; Milisen, Koen; Verschueren, Sabine M P

2011-03-01

Falls in the elderly constitute a growing public health problem. This randomized controlled trial investigated the potential benefit of 6 months of whole body vibration (WBV) training and/or vitamin D supplementation on balance, functionality and estimated fall risk in institutionalized elderly women. A total of 113 women (mean age: 79.6) were randomly assigned to either a WBV or a no-training group, receiving either a conventional dose (880 IU/d) or a high dose (1600 IU/d) of vitamin D3. The WBV group performed exercises on a vibration platform 3×/week. Balance was evaluated by computerized posturography. Functionality was assessed by 10 m walk test, Timed up and Go (TUG) performance and endurance capacity (Shuttle Walk). Fall risk was determined with the Physiological Profile Assessment. Performance on the 10 m walk test and on TUG improved over time in all groups. For none of the parameters, high-dose vitamin D resulted in a better performance than conventional dosing. The improvements in the WBV group in endurance capacity, walking at preferred speed, and TUG were significantly larger than the changes with supplementation alone. No additional benefit of WBV training could be detected on fall risk and postural control, although sway velocity and maximal isometric knee extension strength improved only in the WBV group. This trial showed that a high-dose vitamin D supplementation is not more efficient than conventional dosing in improving functionality in institutionalized elderly. WBV training on top of vitamin D supplementation provided an added benefit with regard to walking, TUG performance, and endurance capacity. Copyright © 2010 Elsevier B.V. All rights reserved.

Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury

PubMed Central

2014-01-01

Background In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities—characterized by increases in the over-ground walking speed and endurance—is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients. Methods Fifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient’s maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients. Results After the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments. Conclusions The improvements of the kinematic and kinetic parameters of the ankle voluntary movement, and their correlation with the functional assessments, support the therapeutic effect of robotic-assisted locomotor training on motor impairment in chronic iSCI. PMID:24684813

The anatomy and biomechanics of running.

PubMed

Nicola, Terry L; Jewison, David J

2012-04-01

To understand the normal series of biomechanical events of running, a comparative assessment to walking is helpful. Closed kinetic chain through the lower extremities, control of the lumbopelvic mechanism, and overall symmetry of movement has been described well enough that deviations from normal movement can now be associated with specific overuse injuries experienced by runners. This information in combination with a history of the runner's errors in their training program will lead to a more comprehensive treatment and prevention plan for related injuries.

Effects of regular exercise training on skeletal muscle contractile function

NASA Technical Reports Server (NTRS)

Fitts, Robert H.

2003-01-01

Skeletal muscle function is critical to movement and one's ability to perform daily tasks, such as eating and walking. One objective of this article is to review the contractile properties of fast and slow skeletal muscle and single fibers, with particular emphasis on the cellular events that control or rate limit the important mechanical properties. Another important goal of this article is to present the current understanding of how the contractile properties of limb skeletal muscle adapt to programs of regular exercise.

A novel walking speed estimation scheme and its application to treadmill control for gait rehabilitation

PubMed Central

2012-01-01

Background Virtual reality (VR) technology along with treadmill training (TT) can effectively provide goal-oriented practice and promote improved motor learning in patients with neurological disorders. Moreover, the VR + TT scheme may enhance cognitive engagement for more effective gait rehabilitation and greater transfer to over ground walking. For this purpose, we developed an individualized treadmill controller with a novel speed estimation scheme using swing foot velocity, which can enable user-driven treadmill walking (UDW) to more closely simulate over ground walking (OGW) during treadmill training. OGW involves a cyclic acceleration-deceleration profile of pelvic velocity that contrasts with typical treadmill-driven walking (TDW), which constrains a person to walk at a preset constant speed. In this study, we investigated the effects of the proposed speed adaptation controller by analyzing the gait kinematics of UDW and TDW, which were compared to those of OGW at three pre-determined velocities. Methods Ten healthy subjects were asked to walk in each mode (TDW, UDW, and OGW) at three pre-determined speeds (0.5 m/s, 1.0 m/s, and 1.5 m/s) with real time feedback provided through visual displays. Temporal-spatial gait data and 3D pelvic kinematics were analyzed and comparisons were made between UDW on a treadmill, TDW, and OGW. Results The observed step length, cadence, and walk ratio defined as the ratio of stride length to cadence were not significantly different between UDW and TDW. Additionally, the average magnitude of pelvic acceleration peak values along the anterior-posterior direction for each step and the associated standard deviations (variability) were not significantly different between the two modalities. The differences between OGW and UDW and TDW were mainly in swing time and cadence, as have been reported previously. Also, step lengths between OGW and TDW were different for 0.5 m/s and 1.5 m/s gait velocities, and walk ratio between OGS and UDW was different for 1.0 m/s gait velocities. Conclusions Our treadmill control scheme implements similar gait biomechanics of TDW, which has been used for repetitive gait training in a small and constrained space as well as controlled and safe environments. These results reveal that users can walk as stably during UDW as TDW and employ similar strategies to maintain walking speed in both UDW and TDW. Furthermore, since UDW can allow a user to actively participate in the virtual reality (VR) applications with variable walking velocity, it can induce more cognitive activities during the training with VR, which may enhance motor learning effects. PMID:22929169

Exercise training improves breathing strategy and performance during the six-minute walk test in obese adolescents.

PubMed

Mendelson, Monique; Michallet, Anne-Sophie; Perrin, Claudine; Levy, Patrick; Wuyam, Bernard; Flore, Patrice

2014-08-15

We aimed to examine ventilatory responses during the six-minute walk test in healthy-weight and obese adolescents before and after exercise training. Twenty obese adolescents (OB) (age: 14.5±1.7 years; BMI: 34.0±4.7kg·m(-2)) and 20 age and gender-matched healthy-weight adolescents (HW) (age: 15.5±1.5 years; BMI: 19.9±1.4kg·m(-2)) completed six-minute walk test during which breath-by-breath gas analysis and expiratory flow limitation (expFL) were measured. OB participated in a 12-week exercise-training program. Comparison between HW and OB participants showed lower distance achieved during the 6MWT in OB (-111.0m, 95%CI: -160.1 to 62.0, p<0.05) and exertional breathlessness was greater (+0.78 a.u., 95%CI: 0.091-3.27, p=0.039) when compared with HW. Obese adolescents breathed at lower lung volumes, as evidenced by lower end expiratory and end inspiratory lung volumes during exercise (p<0.05). Prevalence of expFL (8 OB vs 2 HW, p=0.028) and mean expFL (14.9±21.9 vs 5.32±14.6% VT, p=0.043, in OB and HW) were greater in OB. After exercise training, mean increase in the distance achieved during the 6MWT was 64.5 meters (95%CI: 28.1-100.9, p=0.014) and mean decrease in exertional breathlessness was 1.62 (95%CI: 0.47-2.71, p=0.05). Obese adolescents breathed at higher lung volumes, as evidenced by the increase in end inspiratory lung volume from rest to 6-min exercise (9.9±13.4 vs 20.0±13.6%TLC, p<0.05). Improved performance was associated with improved change in end inspiratory lung volume from rest to 6-min exercise (r=0.65, p=0.025). Our results suggest that exercise training can improve breathing strategy during submaximal exercise in obese adolescents and that this increase is associated with greater exercise performance. Copyright © 2014 Elsevier B.V. All rights reserved.

Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial.

PubMed

Anton, Stephen D; Manini, Todd M; Milsom, Vanessa A; Dubyak, Pamela; Cesari, Matteo; Cheng, Jing; Daniels, Michael J; Marsiske, Michael; Pahor, Marco; Leeuwenburgh, Christiaan; Perri, Michael G

2011-01-01

Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults. Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight, sedentary, older adults. This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese, older adult women. Participants (N = 34) were generally healthy, obese, older adult women (age range 55-79 years) with mild to moderate physical impairments (ie, functional limitations). Participants were randomly assigned to one of two groups for 24 weeks: (i) weight loss plus exercise (WL+E; n = 17; mean age = 63.7 years [4.5]) or (ii) educational control (n = 17; mean age = 63.7 [6.7]). In the WL+E group, participants attended a group-based weight management session plus three supervised exercise sessions within their community each week. During exercise sessions, participants engaged in brisk walking and lower-body resistance training of moderate intensity. Participants in the educational control group attended monthly health education lectures on topics relevant to older adults. Outcomes were: (i) body weight, (ii) walking speed (assessed by 400-meter walk test), (iii) the Short Physical Performance Battery (SPPB), and (iv) knee extension isokinetic strength. Participants randomized to the WL+E group lost significantly more weight than participants in the educational control group (5.95 [0.992] vs 0.23 [0.99] kg; P < 0.01). Additionally, the walking speed of participants in the WL+E group significantly increased compared with that of the control group (reduction in time on the 400-meter walk test = 44 seconds; P < 0.05). Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test (P < 0.05), with significant differences between groups (P = 0.02). Knee extension strength was maintained in both groups. Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle strength in obese, older adult women with mild to moderate physical impairments.

Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial

PubMed Central

Anton, Stephen D; Manini, Todd M; Milsom, Vanessa A; Dubyak, Pamela; Cesari, Matteo; Cheng, Jing; Daniels, Michael J; Marsiske, Michael; Pahor, Marco; Leeuwenburgh, Christiaan; Perri, Michael G

2011-01-01

Background: Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults. Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight, sedentary, older adults. This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese, older adult women. Methods: Participants (N = 34) were generally healthy, obese, older adult women (age range 55–79 years) with mild to moderate physical impairments (ie, functional limitations). Participants were randomly assigned to one of two groups for 24 weeks: (i) weight loss plus exercise (WL+E; n = 17; mean age = 63.7 years [4.5]) or (ii) educational control (n = 17; mean age = 63.7 [6.7]). In the WL+E group, participants attended a group-based weight management session plus three supervised exercise sessions within their community each week. During exercise sessions, participants engaged in brisk walking and lower-body resistance training of moderate intensity. Participants in the educational control group attended monthly health education lectures on topics relevant to older adults. Outcomes were: (i) body weight, (ii) walking speed (assessed by 400-meter walk test), (iii) the Short Physical Performance Battery (SPPB), and (iv) knee extension isokinetic strength. Results: Participants randomized to the WL+E group lost significantly more weight than participants in the educational control group (5.95 [0.992] vs 0.23 [0.99] kg; P < 0.01). Additionally, the walking speed of participants in the WL+E group significantly increased compared with that of the control group (reduction in time on the 400-meter walk test = 44 seconds; P < 0.05). Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test (P < 0.05), with significant differences between groups (P = 0.02). Knee extension strength was maintained in both groups. Conclusion: Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle strength in obese, older adult women with mild to moderate physical impairments. PMID:21753869

A CAI System for Visually Impaired Children to Improve Abilities of Orientation and Mobility

NASA Astrophysics Data System (ADS)

Yoneda, Takahiro; Kudo, Hiroaki; Minagawa, Hiroki; Ohnishi, Noboru; Matsubara, Shizuya

Some visually impaired children have difficulty in simple locomotion, and need orientation and mobility training. We developed a computer assisted instruction system which assists this training. A user realizes a task given by a tactile map and synthesized speech. The user walks around a room according to the task. The system gives the gap of walk path from its target path via both auditory and tactile feedback after the end of a task. Then the user can understand how well the user walked. We describe the detail of the proposed system and task, and the experimental result with three visually impaired children.

Reducing robotic guidance during robot-assisted gait training improves gait function: a case report on a stroke survivor.

PubMed

Krishnan, Chandramouli; Kotsapouikis, Despina; Dhaher, Yasin Y; Rymer, William Z

2013-06-01

To test the feasibility of patient-cooperative robotic gait training for improving locomotor function of a chronic stroke survivor with severe lower-extremity motor impairments. Single-subject crossover design. Performed in a controlled laboratory setting. A 62-year-old man with right temporal lobe ischemic stroke was recruited for this study. The baseline lower-extremity Fugl-Meyer score of the subject was 10 on a scale of 34, which represented severe impairment in the paretic leg. However, the subject had a good ambulation level (community walker with the aid of a stick cane and ankle-foot orthosis) and showed no signs of sensory or cognitive impairments. The subject underwent 12 sessions (3 times per week for 4wk) of conventional robotic training with the Lokomat, where the robot provided full assistance to leg movements while walking, followed by 12 sessions (3 times per week for 4wk) of patient-cooperative robotic control training, where the robot provided minimal guidance to leg movements during walking. Clinical outcomes were evaluated before the start of the intervention, immediately after 4 weeks of conventional robotic training, and immediately after 4 weeks of cooperative control robotic training. These included: (1) self-selected and fast walking speed, (2) 6-minute walk test, (3) Timed Up & Go test, and (4) lower-extremity Fugl-Meyer score. Results showed that clinical outcomes changed minimally after full guidance robotic training, but improved considerably after 4 weeks of reduced guidance robotic training. The findings from this case study suggest that cooperative control robotic training is superior to conventional robotic training and is a feasible option to restoring locomotor function in ambulatory stroke survivors with severe motor impairments. A larger trial is needed to verify the efficacy of this advanced robotic control strategy in facilitating gait recovery after stroke. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Comparison of Combined Aerobic and High-Force Eccentric Resistance Exercise With Aerobic Exercise Only for People With Type 2 Diabetes Mellitus

PubMed Central

Marcus, Robin L; Smith, Sheldon; Morrell, Glen; Addison, Odessa; Dibble, Leland E; Wahoff-Stice, Donna; LaStayo, Paul C

2008-01-01

Background and Purpose: The purpose of this study was to compare the outcomes between a diabetes exercise training program using combined aerobic and high-force eccentric resistance exercise and a program of aerobic exercise only. Subjects and Methods: Fifteen participants with type 2 diabetes mellitus (T2DM) participated in a 16-week supervised exercise training program: 7 (mean age=50.7 years, SD=6.9) in a combined aerobic and eccentric resistance exercise program (AE/RE group) and 8 (mean age=58.5 years, SD=6.2) in a program of aerobic exercise only (AE group). Outcome measures included thigh lean tissue and intramuscular fat (IMF), glycosylated hemoglobin, body mass index (BMI), and 6-minute walk distance. Results: Both groups experienced decreases in mean glycosylated hemoglobin after training (AE/RE group: −0.59% [95% confidence interval (CI)=−1.5 to 0.28]; AE group: −0.31% [95% CI=−0.60 to −0.03]), with no significant between-group differences. There was an interaction between group and time with respect to change in thigh lean tissue cross-sectional area, with the AE/RE group gaining more lean tissue (AE/RE group: 15.1 cm2 [95% CI=7.6 to 22.5]; AE group: −5.6 cm2 [95% CI=−10.4 to 0.76]). Both groups experienced decreases in mean thigh IMF cross-sectional area (AE/RE group: −1.2 cm2 [95% CI=−2.6 to 0.26]; AE group: −2.2 cm2 [95% CI=−3.5 to −0.84]) and increases in 6-minute walk distance (AE/RE group: 45.5 m [95% CI=7.5 to 83.6]; AE group: 29.9 m [95% CI=−7.7 to 67.5]) after training, with no between-group differences. There was an interaction between group and time with respect to change in BMI, with the AE/RE group experiencing a greater decrease in BMI. Discussion and Conclusion: Significant improvements in long-term glycemic control, thigh composition, and physical performance were demonstrated in both groups after participating in a 16-week exercise program. Subjects in the AE/RE group demonstrated additional improvements in thigh lean tissue and BMI. Improvements in thigh lean tissue may be important in this population as a means to increase resting metabolic rate, protein reserve, exercise tolerance, and functional mobility. PMID:18801851

What Did We Learn from the Animal Studies of Body Weight–Supported Treadmill Training and Where Do We Go from Here?

PubMed Central

Dy, Christine J.

2017-01-01

Abstract Body weight–supported treadmill training (BWSTT) developed from animal studies of spinal cord injury (SCI). Evidence that spinal cats (i.e., cats that have a complete surgical transection of the cord) could regain the ability to step on a moving treadmill indicated a vast potential for spinal circuits to generate walking without the brain. BWSTT represented a means to unlock that potential. As the technique was adapted as a rehabilitation intervention for humans with SCI, shortcomings in the translation to walking in the real world were exposed. Evidence that BWSTT has not been as successful for humans with SCI leads us to revisit key animal studies. In this short review, we describe the task-specific nature of BWSTT and discuss how this specificity may pose limits on the recovery of overground walking. Also discussed are more recent studies that have introduced new strategies and tools that adapt BWSTT ideas to more functionally-relevant tasks. We introduce a new device for weight-supported overground walking in rats called Circular BART (Body weight supported Ambulatory Rat Trainer) and demonstrate that it is relatively easy and inexpensive to produce. Future animal studies will benefit from the development of simple tools that facilitate training and testing of overground walking. PMID:27863455

What Did We Learn from the Animal Studies of Body Weight-Supported Treadmill Training and Where Do We Go from Here?

PubMed

de Leon, Ray D; Dy, Christine J

2017-05-01

Body weight-supported treadmill training (BWSTT) developed from animal studies of spinal cord injury (SCI). Evidence that spinal cats (i.e., cats that have a complete surgical transection of the cord) could regain the ability to step on a moving treadmill indicated a vast potential for spinal circuits to generate walking without the brain. BWSTT represented a means to unlock that potential. As the technique was adapted as a rehabilitation intervention for humans with SCI, shortcomings in the translation to walking in the real world were exposed. Evidence that BWSTT has not been as successful for humans with SCI leads us to revisit key animal studies. In this short review, we describe the task-specific nature of BWSTT and discuss how this specificity may pose limits on the recovery of overground walking. Also discussed are more recent studies that have introduced new strategies and tools that adapt BWSTT ideas to more functionally-relevant tasks. We introduce a new device for weight-supported overground walking in rats called Circular BART (Body weight supported Ambulatory Rat Trainer) and demonstrate that it is relatively easy and inexpensive to produce. Future animal studies will benefit from the development of simple tools that facilitate training and testing of overground walking.

Expected for acquisition movement exercise is more effective for functional recovery than simple exercise in a rat model of hemiplegia.

PubMed

Ikeda, Satoshi; Ohwatashi, Akihiko; Harada, Katsuhiro; Kamikawa, Yurie; Yoshida, Akira

2013-01-01

The use of novel rehabilitative approaches for effecting functional recovery following stroke is controversial. Effects of different but effective rehabilitative interventions in the hemiplegic patient are not clear. We studied the effects of different rehabilitative approaches on functional recovery in the rat photochecmical cerebral infarction model. Twenty-four male Wistar rats aged 8 weeks were used. The cranial bone was exposed under deep anesthesia. Rose bengal (20 mg/kg) was injected intravenously, and the sensorimotor area of the cerebral cortex was irradiated transcranially for 20 min with a light beam of 533-nm wavelength. Animals were divided into 3 groups. In the simple-exercise group, treadmill exercise was performed for 20 min every day. In the expected for acquisition movement-training group, beam-walking exercise was done for 20 min daily. The control group was left to recover without additional intervention. Hindlimb function was evaluated with the beam-walking test. Following cerebral infarction, dysfunction of the contralateral extremities was observed. Functional recovery was observed earlier in the expected for acquisition training group than in the other groups. Although rats in the treadmill group recovered more quickly than controls, the beam-walking group had the shortest overall recovery time. Exercise facilitated functional recovery in the rat hemiplegic model, and expected for acquisition exercise was more effective than simple exercise. These findings are considered to have important implications for the future development of clinical rehabilitation programs.

Comparison of metabolic responses of United States Military Academy men and women in acute military load bearing.

PubMed

Stauffer, R W; McCarter, M; Campbell, J L; Wheeler, L F

1987-11-01

Twenty-four first year United States Military Academy (USMA) men and women were studied to compare metabolic response differences in seven horizontal walking velocities, under three military load bearing conditions. The treadmill protocol consisted of walking or jogging on a horizontal treadmill surface for 3-min intervals at velocities of 3, 3.5, 4, 4.5, 5, 5.5, and 6 mph. The three military load bearing conditions weighed 5, 12, and 20 kg. Metabolic measurements taken at each speed in each of the military load bearing conditions were: minute volume, tidal volume, respiratory rate, absolute and relative to body weight oxygen consumption, and respiratory quotient. Two three-way analyses of variance for repeated measures tests with main effects of gender, military load, and speed revealed that USMA men and women metabolically respond to different military load bearing conditions; they metabolically respond to different walking and jogging velocities under military load bearing conditions; and they have identifiable and quantifiable metabolic response differences to military load bearing. This study was designed to improve USMA physical and military training programs by providing information to equally and uniformly administer the USMA Doctrine of Comparable Training to men and women alike; and additionally to clarify the "...minimal essential adjustments...required because of physiological differences between male and female individuals ..." portion of Public Law 94-106 providing for the admission of women to America's Service Academies.

A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial.

PubMed

Pichierri, Giuseppe; Murer, Kurt; de Bruin, Eling D

2012-12-14

Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults. This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming. The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults. Thirty-one participants (mean age ± SD: 86.2 ± 4.6 years), residents of two Swiss hostels for the aged, were randomly assigned to either the dance group (n = 15) or the control group (n = 16). The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming. The control group performed only the strength and balance exercises during this period. Outcome measures were foot placement accuracy, gait performance under single and dual task conditions, and falls efficacy. After the intervention between-group comparison revealed significant differences for gait velocity (U = 26, P = .041, r = .45) and for single support time (U = 24, P = .029, r = .48) during the fast walking dual task condition in favor of the dance group. No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy. There was a significant interaction in favor of the dance video game group for improvements in step time. Significant improved fast walking performance under dual task conditions (velocity, double support time, step length) was observed for the dance video game group only. These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program. This trial has been registered under ISRCTN05350123 (www.controlled-trials.com)

An Accelerated Multi-Modality Rehabilitation Protocol Combined with Botulinum Toxin-A Injection in Adult Idiopathic Toe Walking: Case Report

PubMed Central

Yavuz, Ferdi; Balaban, Birol

2016-01-01

Diagnosis of Adult Idiopathic Toe Walking (AITW) is very rare in clinical practice. High quality studies regarding AITW and its treatment options have not been conducted previously. A 28-year-old male patient complaining of lower leg pain was referred to outpatient rehabilitation clinic. Physical examination revealed a gait abnormality of insufficient heel strike at initial contact. The aetiology was investigated and the patient’s walking parameters were assessed using a computerized gait analysis system. The AITW was diagnosed. Botulinum toxin-A (Dysport®) was injected to the bilateral gastrocnemius muscles. A combined 10-days rehabilitation program was designed, including a daily one-hour physiotherapist supervised exercise program, ankle dorsiflexion exercises using an EMG-biofeedback unit assisted virtual rehabilitation system (Biometrics) and virtual gait training (Rehawalk) every other day. After treatment, the patient was able to heel strike at the initiation of the stance phase of the gait. Ankle dorsiflexion range of motions increased. The most prominent improvement was seen in maximum pressure and heel force. In addition center of pressure evaluations were also improved. To the best of our knowledge this is the first case, of AITW treated with combined botulinum toxin, exercise and virtual rehabilitation systems. This short report demonstrates the rapid effect of this 10-days combined therapy. PMID:27504395

Not just a walk in the park: efficacy to effectiveness for after school programs in communities of concentrated urban poverty.

PubMed

Frazier, Stacy L; Mehta, Tara G; Atkins, Marc S; Hur, Kwan; Rusch, Dana

2013-09-01

This study examined a model for mental health consultation, training and support designed to enhance the benefits of publicly-funded recreational after-school programs in communities of concentrated urban poverty for children's academic, social, and behavioral functioning. We assessed children's mental health needs and examined the feasibility and impact of intervention on program quality and children's psychosocial outcomes in three after-school sites (n = 15 staff, 89 children), compared to three demographically-matched sites that received no intervention (n = 12 staff, 38 children). Findings revealed high staff satisfaction and feasibility of intervention, and modest improvements in observed program quality and staff-reported children's outcomes. Data are considered with a public health lens of mental health promotion for children in urban poverty.

Effectiveness of Functional Progressive Resistance Exercise Training on Walking Ability in Children with Cerebral Palsy: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Scholtes, Vanessa A.; Becher, Jules G.; Janssen-Potten, Yvonne J.; Dekkers, Hurnet; Smallenbroek, Linda; Dallmeijer, Annet J.

2012-01-01

The objective of the study was to evaluate the effectiveness of functional progressive resistance exercise (PRE) training on walking ability in children with cerebral palsy (CP). Fifty-one ambulant children with spastic CP (mean age 10 years 5 months, 29 boys) were randomized to an intervention (n=26) or control group (n=25, receiving usual care).…

MIT-Skywalker: considerations on the Design of a Body Weight Support System.

PubMed

Gonçalves, Rogério Sales; Krebs, Hermano Igo

2017-09-06

To provide body weight support during walking and balance training, one can employ two distinct embodiments: support through a harness hanging from an overhead system or support through a saddle/seat type. This paper presents a comparison of these two approaches. Ultimately, this comparison determined our selection of the body weight support system employed in the MIT-Skywalker, a robotic device developed for the rehabilitation/habilitation of gait and balance after a neurological injury. Here we will summarize our results with eight healthy subjects walking on the treadmill without any support, with 30% unloading supported by a harness hanging from an overhead system, and with a saddle/seat-like support system. We compared the center of mass as well as vertical and mediolateral trunk displacements across different walking speeds and support. The bicycle/saddle system had the highest values for the mediolateral inclination, while the overhead harness body weight support showed the lowest values at all speeds. The differences were statistically significant. We selected the bicycle/saddle system for the MIT-Skywalker. It allows faster don-and-doff, better centers the patient to the split treadmill, and allows all forms of training. The overhead harness body weight support might be adequate for rhythmic walking training but limits any potential for balance training.

Training Cambodian Village Health Support Guides in Diabetes Prevention: Effects on Guides' Knowledge and Teaching Activities Over 6 Months.

PubMed

Wagner, Julie; Keuky, Lim; Fraser-King, Lorraine; Kuoch, Theanvy; Scully, Mary

2016-04-01

Type 2 diabetes is a pressing public health concern in Cambodia, a country with limited human resource capacity due to genocide. Cambodian village health support guides (Guides) promote health at the local level. This paper reports preliminary results of training Guides in diabetes prevention. The curriculum, called Eat, Walk, Sleep was delivered to Guides in Siem Reap province once over 3 h. Participants completed a pretest and posttest on diabetes knowledge. Guides were offered continuing education through Eat, Walk, Sleep resources and were encouraged to teach Eat, Walk, Sleep in their villages. For each of 6 months following their training, Guides completed a checklist regarding their activities. One hundred eighty-five Guides attended one of ten trainings. Knowledge scores increased significantly from pretest to posttest. During 6 months of follow-up, n = 159 Guides (85 %) completed at least one monthly checklist. Guides reported high rates of uptake and delivery of the Eat, Walk, Sleep curriculum and moderate rates of continuing education about diabetes. Diabetes prevention in Cambodia is nascent. Guides show excellent uptake and dissemination of the curriculum. Future research should examine effect of support for Guide activities and the effect of the curriculum on villager health behaviors, and ultimately, on rates of type 2 diabetes.

Online Phase Detection Using Wearable Sensors for Walking with a Robotic Prosthesis

PubMed Central

Goršič, Maja; Kamnik, Roman; Ambrožič, Luka; Vitiello, Nicola; Lefeber, Dirk; Pasquini, Guido; Munih, Marko

2014-01-01

This paper presents a gait phase detection algorithm for providing feedback in walking with a robotic prosthesis. The algorithm utilizes the output signals of a wearable wireless sensory system incorporating sensorized shoe insoles and inertial measurement units attached to body segments. The principle of detecting transitions between gait phases is based on heuristic threshold rules, dividing a steady-state walking stride into four phases. For the evaluation of the algorithm, experiments with three amputees, walking with the robotic prosthesis and wearable sensors, were performed. Results show a high rate of successful detection for all four phases (the average success rate across all subjects >90%). A comparison of the proposed method to an off-line trained algorithm using hidden Markov models reveals a similar performance achieved without the need for learning dataset acquisition and previous model training. PMID:24521944

Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report

PubMed Central

2011-01-01

Background Robotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation. Methods The study group comprised 16 stroke patients with severe hemiplegia. All patients underwent gait training. Four patients required assistance, and 12 needed supervision while walking. The stride length, walking speed and physiological cost index on wearing the hybrid assistive limb suit and a knee-ankle-foot orthosis were compared. Results The hybrid assistive limb suit increased the stride length and walking speed in 4 of 16 patients. The patients whose walking speed decreased on wearing the hybrid assistive limb suit either had not received sufficient gait training or had an established gait pattern with a knee-ankle-foot orthosis using a quad cane. The physiological cost index increased after wearing the hybrid assistive limb suit in 12 patients, but removal of the suit led to a decrease in the physiological cost index values to equivalent levels prior to the use of the suit. Conclusions Although the hybrid assistive limb suit is not useful for all hemiplegic patients, it may increase the walking speed and affect the walking ability. Further investigation would clarify its indication for the possibility of gait training. PMID:21943320

Compliance of Children with Moderate to Severe Intellectual Disability to Treadmill Walking: A Pilot Study

ERIC Educational Resources Information Center

Vashdi, E.; Hutzler, Y.; Roth, D.

2008-01-01

Background: Individuals with Intellectual Disability (ID) exhibit reduced levels of compliance to exercise, including treadmill walking. The purpose of this study was to measure the effects of several training conditions on compliance to participation in treadmill walking of children with moderate to severe ID. Method: Criteria for compliance were…

Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia.

PubMed

Leutwyler, H; Hubbard, E; Cooper, B A; Dowling, G

2017-11-10

The purpose of this report is to describe the impact of a videogame-based physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA) on walking speed in adults with schizophrenia. In this randomized controlled trial, 28 participants played either an active videogame for 30 min (intervention group) or played a sedentary videogame for 30 min (control group), once a week for 6 weeks. Walking speed was measured objectively with the Short Physical Performance Battery at enrollment and at the end of the 6-week program. The intervention group (n = 13) showed an average improvement in walking speed of 0.08 m/s and the control group (n = 15) showed an average improvement in walking speed of 0.03 m/s. Although the change in walking speed was not statistically significant, the intervention group had between a small and substantial clinically meaningful change. The results suggest a videogame based physical activity program provides clinically meaningful improvement in walking speed, an important indicator of health status.

Exercise program adherence using a 5-kilometer (5K) event as an achievable goal in people with schizophrenia.

PubMed

Warren, Kimberly R; Ball, M Patricia; Feldman, Stephanie; Liu, Fang; McMahon, Robert P; Kelly, Deanna L

2011-10-01

People with schizophrenia have a higher prevalence of obesity than the general population. Many people with this illness struggle with weight gain, due, in part, to medications and other factors that act as obstacles to exercise and healthy eating. Several studies have shown the benefits of behavioral weight loss programs targeting eating and/or exercise in people with schizophrenia. Fewer studies have used competitive events as a goal for an exercise program. The current study tested the feasibility of preparing, using an exercise program, for a 5-kilometer (5K) event in people with schizophrenia. The exercise program was a 10-week training program consisting of three supervised walking/jogging sessions per week and a weekly educational meeting on healthy behaviors. Almost 65% (11/17) of the subjects participated in all of the training sessions, and 82% (14/17) participated in the 5K event. Participants did not gain a significant amount of weight during the exercise program (median weight change = 0.7 kg; 25th percentile 0.5, 75th percentile 3.9, p = .10). This study suggests that using an achievable goal, such as a 5K event, promotes adherence to an exercise program and is feasible in a population of people with chronic schizophrenia.

Effects of aquatic exercise training using water-resistance equipment in elderly.

PubMed

Katsura, Yoshihiro; Yoshikawa, Takahiro; Ueda, Shin-Ya; Usui, Tatsuya; Sotobayashi, Daisuke; Nakao, Hayato; Sakamoto, Hiroshi; Okumoto, Tamiko; Fujimoto, Shigeo

2010-03-01

To prevent falls in Japan, both gait and resistance training of the lower extremities are recommended. However, resistance training for the elderly induces muscle damage. Recently, aquatic exercise using water buoyancy and resistance have commonly been performed by the elderly. We have now produced new water-resistance equipment. The purpose of the present study was to evaluate the efficacy of aquatic exercise training using the new equipment for the elderly. Subjects were divided into two groups: a resistance group of 12 subjects (using water-resistance equipment) and a non-resistance group of eight subjects (without the equipment). The aquatic exercise training was 90 min, three times per week for 8 weeks, and mostly consisted of walking. All subjects underwent anthropometric measurements, physical performance testing, and profile of mood states (POMS). Significant improvements were observed in muscle strength in plantar flexion, and the timed up and go test (TUG) in both groups. Additionally, 10-m obstacle walking and 5-m maximum walking speed and length with eye-open were significantly improved in the resistance group. Also, a low negative correlation was found between the degree of change in TUG and POMS (tension and anxiety) scores in the resistance group. As it became easier to maintain posture, stand, and move, tension and anxiety in everyday life were alleviated with improvement of strength of the lower extremities and balance function. The present aquatic exercise training using water-resistance equipment may be used by the elderly to improve balance and walking ability, which are associated with the prevention of falls.

The effect of rhythmic musical training on healthy older adults' gait and cognitive function.

PubMed

Maclean, Linda M; Brown, Laura J E; Astell, Arlene J

2014-08-01

Older adults' gait is disturbed when a demanding secondary cognitive task is added. Gait training has been shown to improve older adults' walking performance, but it is not clear how training affects their cognitive performance. This study examined the impact on gait, in terms of cost or benefit to cognitive performance, of training healthy older adults to walk to a rhythmic musical beat. In a mixed model design, 45 healthy older adults aged more than 65 years (M = 71.7 years) were randomly assigned to 3 groups. One group received a rhythmic musical training and their dual-task (DT) walking and cognitive performances were compared with a group who had music playing in the background but no training, and a third group who heard no music and received no training. Outcomes in single-task (ST) and DT conditions were step-time variability and velocity for gait and correct cognitive responses for the cognitive task. The Musical Training group's step-time variability improved in both the ST (p < .05) and the DT (p < .05) after training, without adversely affecting their cognitive performance. No change was seen in the control groups. Rhythmic musical training can improve gait steadiness in healthy older adults with no negative impact on concurrent cognitive functioning. This could potentially enhance "postural reserve" and reduce fall risk. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

High-intensity exercise training for the prevention of type 2 diabetes mellitus.

PubMed

Rynders, Corey A; Weltman, Arthur

2014-02-01

Aerobic exercise training and diet are recommended for the primary prevention of type 2 diabetes mellitus and cardiovascular disease. The American Diabetes Association (ADA) recommends that adults with prediabetes engage in ≥ 150 minutes per week of moderate activity and target a 7% weight loss. However, traditional moderate-intensity (MI) exercise training programs are often difficult to sustain for prediabetic adults; a commonly cited barrier to physical activity in this population is the "lack of time" to exercise. When matched for total energy expenditure, high-intensity (HI) exercise training has a lower overall time commitment compared with traditional low-intensity (LI) or MI exercise training. Several recent studies comparing HI exercise training with LI and MI exercise training reported that HI exercise training improves skeletal muscle metabolic control and cardiovascular function in a comparable and/or superior way relative to LI and MI exercise training. Although patients can accrue all exercise benefits by performing LI or MI activities such as walking, HI activities represent a time-efficient alternative to meeting physical activity guidelines. High-intensity exercise training is a potent tool for improving cardiometabolic risk for prediabetic patients with limited time and may be prescribed when appropriate.

Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients

PubMed Central

2010-01-01

Background Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine. Methods The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks. Results The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability. Conclusions The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies. PMID:20584307

Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients.

PubMed

Hesse, Stefan; Waldner, Andreas; Tomelleri, Christopher

2010-06-28

Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine. The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks. The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability. The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

Robot-Assisted Training Early After Cardiac Surgery.

PubMed

Schoenrath, Felix; Markendorf, Susanne; Brauchlin, Andreas E; Seifert, Burkhardt; Wilhelm, Markus J; Czerny, Martin; Riener, Robert; Falk, Volkmar; Schmied, Christian M

2015-07-01

To assess feasibility and safety of a robot-assisted gait therapy with the Lokomat® system in patients early after open heart surgery. Within days after open heart surgery 10 patients were subjected to postoperative Lokomat® training (Intervention group, IG) whereas 20 patients served as controls undergoing standard postoperative physiotherapy (Control group, CG). All patients underwent six-minute walk test and evaluation of the muscular strength of the lower limbs by measuring quadriceps peak force. The primary safety end-point was freedom from any device-related wound healing disturbance. Patients underwent clinical follow-up after one month. Both training methods resulted in an improvement of walking distance (IG [median, interquartile range, p-value]: +119 m, 70-201 m, p = 0.005; CG: 105 m, 57-152.5m, p < 0.001) and quadriceps peak force (IG left: +5 N, 3.8 7 N, p = 0.005; IG right: +3.5 N, 1.5-8.8 N, p = 0.011; CG left: +5.5 N, 4-9 N, p < 0.001; CG right: +6 N, 4.3-9.8 N, p < 0.001) in all participants. Results with robot-assisted training were comparable to early postoperative standard in hospital training (median changes in walking distance in percent, p = 0.81; median changes in quadriceps peak force in percent, left: p = 0.97, right p = 0.61). No deep sternal wound infection or any adverse event occurred in the robot-assisted training group. Robot-assisted gait therapy with the Lokomat® system is feasible and safe in patients early after median sternotomy. Results with robot-assisted training were comparable to standard in hospital training. An adapted and combined aerobic and resistance training intervention with augmented feedback may result in benefits in walking distance and lower limb muscle strength (ClinicalTrials.gov number, NCT 02146196). © 2015 Wiley Periodicals, Inc.

Low-Volume Whole-Body Vibration Training Improves Exercise Capacity in Subjects With Mild to Severe COPD.

PubMed

Spielmanns, Marc; Boeselt, Tobias; Gloeckl, Rainer; Klutsch, Anja; Fischer, Henrike; Polanski, Henryk; Nell, Christoph; Storre, Jan H; Windisch, Wolfram; Koczulla, Andreas R

2017-03-01

The objective of this study was to investigate the benefits of a low-volume out-patient whole-body vibration training (WBVT) program on exercise capacity in comparison with a calisthenics training program in subjects with COPD. In this single-center randomized controlled trial, 29 subjects with mild to severe COPD were randomized to WBVT or to calisthenics training, including relaxation and breathing retraining in combination with calisthenics exercises. Both groups equally exercised for a duration of 3 months with 2 sessions of 30 min/week. Outcome parameters were 6-min walk distance (6MWD, primary outcome), 5-repetition sit-to-stand test, leg press peak force, Berg balance scale, St George Respiratory Questionnaire, and COPD assessment test. Twenty-seven subjects completed the study (WBVT, n = 14; calisthenics training program, n = 13). Baseline characteristics between groups were comparable. Subjects in the WBVT group significantly improved median (interquartile range) 6MWD (+105 [45.5-133.5] m, P = .001), sit-to-stand test (-2.3 [-3.1 to -1.3] s, P = .001), peak force (28.7 [16.7-33.3] kg, P = .001), and Berg balance scale (1.5 [0.0-4.0] points, P = .055). Changes in 6MWD, sit-to-stand test, and leg press peak force were also found to be significantly different between groups in favor of the WBVT group. Only the between-group difference of the COPD assessment test score was in favor of the calisthenics training group ( P = .02). A low-volume WBVT program resulted in significantly and clinically relevant larger improvements in exercise capacity compared with calisthenics exercises in subjects with mild to severe COPD. (ClinicalTrials.gov registration DRKS9706.). Copyright © 2017 by Daedalus Enterprises.

Energy expenditure during 2-day trail walking in the mountains (2,857 m) and the effects of amino acid supplementation in older men and women.

PubMed

Shimizu, Muneshige; Miyagawa, Ken; Iwashita, Soh; Noda, Tsuneyuki; Hamada, Koichiro; Genno, Hirokazu; Nose, Hiroshi

2012-03-01

We compared relative exercise intensity and active energy expenditure (AEE) on trail walking in the mountains, with those of daily exercise training, and whether branched-chain amino acid (BCAA) and arginine supplementation attenuated the release of markers indicating muscle damage and declines in physical performance. Twenty-one subjects (~63 years) were divided into two groups: amino acid (AA, 51 g of amino acids and 40 g of carbohydrate, male/female = 6/4) or placebo (PL, 91 g of carbohydrate, male/female = 6/5) supplementation during 2 days of trail walking in the mountains. We measured heart rate (HR), AEE, fatigue sensation, water and food intake, and sweat loss during walking. In addition, we measured peak aerobic capacity [Formula: see text] and heart rate (HR(peak)) with graded-intensity walking, vertical jumping height (VJ) before and after walking. We found that average HR and AEE during uphill walking were ~100% HR(peak) and ~60% [Formula: see text], while they were ~80 and ~20% during downhill walking, respectively. Moreover, average total AEE per day was sevenfold that of their daily walking training. VJ after walking remained unchanged compared with the baseline in AA (P > 0.2), while it was reduced by ~10% in PL (P < 0.01), although with no significant difference in the reduction between the groups (P > 0.4). The responses of other variables were not significantly different between groups (all, P > 0.2). Thus, trail walking in the mountains required a high-intensity effort for older people, while the effects of BCAA and arginine supplementation were modest in this condition.

It's how you get there: walking down a virtual alley activates premotor and parietal areas.

PubMed

Wagner, Johanna; Solis-Escalante, Teodoro; Scherer, Reinhold; Neuper, Christa; Müller-Putz, Gernot

2014-01-01

Voluntary drive is crucial for motor learning, therefore we are interested in the role that motor planning plays in gait movements. In this study we examined the impact of an interactive Virtual Environment (VE) feedback task on the EEG patterns during robot assisted walking. We compared walking in the VE modality to two control conditions: walking with a visual attention paradigm, in which visual stimuli were unrelated to the motor task; and walking with mirror feedback, in which participants observed their own movements. Eleven healthy participants were considered. Application of independent component analysis to the EEG revealed three independent component clusters in premotor and parietal areas showing increased activity during walking with the adaptive VE training paradigm compared to the control conditions. During the interactive VE walking task spectral power in frequency ranges 8-12, 15-20, and 23-40 Hz was significantly (p ≤ 0.05) decreased. This power decrease is interpreted as a correlate of an active cortical area. Furthermore activity in the premotor cortex revealed gait cycle related modulations significantly different (p ≤ 0.05) from baseline in the frequency range 23-40 Hz during walking. These modulations were significantly (p ≤ 0.05) reduced depending on gait cycle phases in the interactive VE walking task compared to the control conditions. We demonstrate that premotor and parietal areas show increased activity during walking with the adaptive VE training paradigm, when compared to walking with mirror- and movement unrelated feedback. Previous research has related a premotor-parietal network to motor planning and motor intention. We argue that movement related interactive feedback enhances motor planning and motor intention. We hypothesize that this might improve gait recovery during rehabilitation.

Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial.

PubMed

van Bloemendaal, Maijke; Bus, Sicco A; de Boer, Charlotte E; Nollet, Frans; Geurts, Alexander C H; Beelen, Anita

2016-10-01

Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly limited to the orthotic effects of peroneal functional electrical stimulation in the chronic phase after stroke. The aim of this study is to investigate the therapeutic effects of up to 10 weeks of multi-channel functional electrical stimulation (MFES)-assisted gait training on the restoration of spatiotemporal gait symmetry and walking capacity in subacute stroke patients. In a proof-of-principle study with a randomised controlled design, 40 adult patients with walking deficits who are admitted for inpatient rehabilitation within 31 days since the onset of stroke are randomised to either MFES-assisted gait training or conventional gait training. Gait training is delivered in 30-minute sessions each workday for up to 10 weeks. The step length symmetry ratio is the primary outcome. Blinded assessors conduct outcome assessments at baseline, every 2 weeks during the intervention period, immediately post intervention and at 3-month follow-up. This study aims to provide preliminary evidence for the feasibility and effectiveness of MFES-assisted gait rehabilitation early after stroke. Results will inform the design of a larger multi-centre trial. This trial is registered at the Netherlands Trial Register (number NTR4762 , registered 28 August 2014).

Hybrid Assistive Limb Exoskeleton HAL in the Rehabilitation of Chronic Spinal Cord Injury: Proof of Concept; the Results in 21 Patients.

PubMed

Jansen, Oliver; Grasmuecke, Dennis; Meindl, Renate C; Tegenthoff, Martin; Schwenkreis, Peter; Sczesny-Kaiser, Matthias; Wessling, Martin; Schildhauer, Thomas A; Fisahn, Christian; Aach, Mirko

2018-02-01

The use of mobile exoskeletons is becoming more and more common in the field of spinal cord injury (SCI) rehabilitation. The hybrid assistive limb (HAL) exoskeleton provides a tailored support depending on the patient's voluntary drive. After a pilot study in 2014 that included 8 patients with chronic SCI, this study of 21 patients with chronic SCI serves as a proof of concept. It was conducted to provide further evidence regarding the efficacy of exoskeletal-based rehabilitation. Functional assessment included walking speed, distance, and time on a treadmill, with additional analysis of functional mobility using the following tests: 10-meter walk test (10MWT), timed up and go (TUG) test, 6-minute walk test (6MWT), and the walking index for SCI II (WISCI-II) score. After a training period of 90 days, all 21 patients significantly improved their functional and ambulatory mobility without the exoskeleton. Patients were assessed by the 6MWT, the TUG test, and the 10MWT, which also indicated an increase in the WISCI-II score along with significant improvements in HAL-associated walking speed, distance, and time. Although, exoskeletons are not yet an established treatment in the rehabilitation of spinal cord injuries, the devices will play a more important role in the future. The HAL exoskeleton training enables effective, body weight-supported treadmill training and is capable of improving ambulatory mobility. Future controlled studies are required to enable a comparison of the new advances in the field of SCI rehabilitation with traditional over-ground training. Copyright © 2017 Elsevier Inc. All rights reserved.

Lipid and lipoprotein changes in women following 6 months of exercise training in a worksite fitness program.

PubMed

Grandjean, P W; Oden, G L; Crouse, S F; Brown, J A; Green, J S

1996-03-01

It was the purpose of this investigation to examine the influence of a worksite aerobic training program on serum lipid and lipoproteins and cardiovascular fitness in female employees. Thirty-seven healthy but previously untrained, female employees (Ss) from Westinghouse Corporation, (College Station, Texas) volunteered for the study. Ss were randomly assigned to either an exercise group (Ex) (n = 20) or control group (C) (n = 17). Prior to training (PRE) and following training (POST), all Ss were measured for weight (WT), body composition (%FAT) and tested for maximal oxygen consumption (VO2 max). PRE and POST Lipid analysis included: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TG). Following PRE testing, the Ex group aerobically trained by walking, jogging and/or cycling, at least 3 days per wk for 24 wks. Exercise training resulted in an improvement in VO2 max (p < 0.0006) and a 2 kg WT loss in Ex (p < 0.025) with no change in C. Both Ex and C Ss exhibited a loss in %-FAT (p < 0.0001), and a decrease in TC (p < 0.0001) and LDL-C (p < 0.0001). No differences were observed between groups or over the training period for VLDL-C or TG. Although HDL-C increased 6 mg/dl in the Ex group but not in C, this difference did not reach statistical significance (p < 0.0625). These results demonstrate that aerobic training by females in a worksite fitness program significantly improves cardiovascular fitness without altering lipids or lipoproteins.

Internet-based home training is capable to improve balance in multiple sclerosis: a randomized controlled trial.

PubMed

Frevel, D; Mäurer, M

2015-02-01

Balance disorders are common in multiple sclerosis. Aim of the study is to investigate the effectiveness of an Internet-based home training program (e-Training) to improve balance in patients with multiple sclerosis. A randomized, controlled study. Academic teaching hospital in cooperation with the therapeutic riding center Gut Üttingshof, Bad Mergentheim. Eighteen multiple sclerosis patients (mean EDSS 3,5) took part in the trial. Outcome of patients using e-Training (N.=9) was compared to the outcome of patients receiving hippotherapy (N.=9), which can be considered as an advanced concept for the improvement of balance and postural control in multiple sclerosis. After simple random allocation patients received hippotherapy or Internet-based home training (balance, postural control and strength training) twice a week for 12 weeks. Assessments were done before and after the intervention and included static and dynamic balance (primary outcome). Isometric muscle strength of the knee and trunk extension/flexion (dynamometer), walking capacity, fatigue and quality of life served as secondary outcome parameters. Both intervention groups showed comparable and highly significant improvement in static and dynamic balance capacity, no difference was seen between the both intervention groups. However looking at fatigue and quality of life only the group receiving hippotherapy improved significantly. Since e-Training shows even comparable effects to hippotherapy to improve balance, we believe that the established Internet-based home training program, specialized on balance and postural control training, is feasible for a balance and strength training in persons with multiple sclerosis. We demonstrated that Internet-based home training is possible in patients with multiple sclerosis.

Physical and psychological benefits of a 24-week traditional dance program in breast cancer survivors.

PubMed

Kaltsatou, Antonia; Mameletzi, Dimitra; Douka, Stella

2011-04-01

The purpose of the present study was to evaluate the influence of a mixed exercise program, including Greek traditional dances and upper body training, in physical function, strength and psychological condition of breast cancer survivors. Twenty-seven women (N = 27), who had been diagnosed and surgically treated for breast cancer, volunteered to participate in this study. The experimental group consisted of 14 women with mean age 56.6 (4.2) years. They attended supervised Greek traditional dance courses and upper body training (1 h, 3 sessions/week) for 24 weeks. The control group consisted of 13 sedentary women with mean age 57.1 (4.1) years. Blood pressure, heart rate, physical function (6-min walking test), handgrip strength, arm volume and psychological condition (Life Satisfaction Inventory and Beck Depression Inventory) were evaluated before and after the exercise program. The results showed significant increases of 19.9% for physical function, 24.3% for right handgrip strength, 26.1% for left handgrip strength, 36.3% for life satisfaction and also a decrease of 35% for depressive symptoms in the experimental group after the training program. Significant reductions of 9% for left hand and 13.7% for right hand arm volume were also found in the experimental group. Consequently, aerobic exercise with Greek traditional dances and upper body training could be an alternative choice of physical activity for breast cancer survivors, thus promoting benefits in physical function, strength and psychological condition. Copyright © 2010 Elsevier Ltd. All rights reserved.

A Novel Treadmill with a Function of Simulating Walkway-Walking

NASA Astrophysics Data System (ADS)

Funabiki, Shigeyuki; Nishiyama, Shinji; Tanaka, Toshihiko; Fujihara, Jun-Ichi; Maniwa, Sokichi; Sakai, Yasuo

There are differences between walkway walking and walking on a treadmill. It is considered that these differences are based on the fact that the walking on the treadmill is a passive motion, while the walkway walking is an active motion. The differences in walking between on a floor and on a treadmill are investigated using the electromyograph and on the oral questionnaires from subjects. The obtained knowledge is as follows. (1) The muscular activity of the legs in walking on the treadmill without the tractive force is smaller than that in walking on the floor. (2) The walking on the treadmill with 60% of the tractive force being equivalent to the walkway walking from the rear downward of 30 degrees becomes similar to the usual walking on the floor. This paper proposes a novel treadmill with a function of simulating walkway-walking. The developed treadmill has a walking-load device towing the subject from the rear downward and controlling the walking speed according to the position of subject on the treadmill. The verification experiment of walking on the developed treadmill shows the availability to gait training and rehabilitation.

Influence of a walking program on the metabolic risk profile of obese postmenopausal women.

PubMed

Roussel, Michel; Garnier, Sophie; Lemoine, Sophie; Gaubert, Isabelle; Charbonnier, Laurie; Auneau, Gérard; Mauriège, Pascale

2009-01-01

Menopause transition is associated with an increased prevalence of metabolic syndrome (MS), which may partly explain the higher coronary heart disease risk. The aim of this study was to examine the impact of a 16-week walking program on the metabolic risk profile of women 50 to 65 years old whose body mass index ranged from 29 to 35 kg/m. A total of 153 postmenopausal women were subjected to three sessions per week of 45-minutes of walking at 60% of their heart rate reserve. At baseline, 46 and 84 women were characterized by one and two or more determinants of MS, respectively, whereas 23 women did not show this condition. Body composition, resting blood pressure, fasting lipid-lipoprotein profile, and cardiorespiratory fitness (CRF) were measured before and after exercise. In the whole sample of 153 women, CRF estimated by V(O2max) increased in response to walking (P < 0.0001). Endurance training promoted body weight and fat mass losses and reduced waist girth and blood pressure, whereas it decreased plasma triglyceride, cholesterol, and low-density lipoprotein cholesterol levels and increased high-density lipoprotein cholesterol concentrations (P < 0.0001). Improvements in lipid-lipoprotein levels were not associated with increases in CRF but seemed to be dependent on reduced body fatness. However, the greatest ameliorations in metabolic risk profile were found in women characterized by two or more determinants of MS at baseline than in the two other groups (0.05 < P < 0.0001). A moderate-intensity physical activity is thus sufficient to reduce the metabolic risk profile of postmenopausal women characterized by the presence of one or several clinical features of MS but without overt coronary heart disease.

A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot Study

PubMed Central

Forestieri, Patrícia; Guizilini, Solange; Peres, Monique; Bublitz, Caroline; Bolzan, Douglas W.; Rocco, Isadora S.; Santos, Vinícius B.; Moreira, Rita Simone L.; Breda, João R.; de Almeida, Dirceu R.; Carvalho, Antonio Carlos de C.; Arena, Ross; Gomes, Walter J.

2016-01-01

Objective The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P=0.08 and P=0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P<0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P=0.22 and P<0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P<0.01). Conclusion Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support. PMID:27982348

[Walking assist robot and its clinical application].

PubMed

Kakou, Hiroaki; Shitama, Hideo; Kimura, Yoshiko; Nakamoto, Yoko; Furuta, Nami; Honda, Kanae; Wada, Futoshi; Hachisuka, Kenji

2009-06-01

The walking assist robot was developed to improve gait disturbance in patients with severe disabilities. The robot had a trunk supporter, power generator and operating arms which held patient's lower extremities and simulated walking, a control unit, biofeedback system, and a treadmill. We applied the robot-aided gait training to three patients with severe gait disturbance induced by stroke, axonal Guillan-Barré syndrome or spinal cord injury, and the walking assist robot turned out to be effective in improving the gait disturbance.

Youth walking and biking rates vary by environments around 5 Louisiana schools.

PubMed

Gustat, Jeanette; Richards, Katherine; Rice, Janet; Andersen, Lori; Parker-Karst, Kathryn; Cole, Shalanda

2015-01-01

The prevalence of obesity in children is high, and many do not meet physical activity recommendations. The Safe Routes to School (SRTS) program encourages school-aged children to walk and bike to school. We assessed the condition of the walking/biking environment around schools in Louisiana prior to the state's first SRTS program. Assessments were made at the neighborhood level with the Pedestrian Environmental Data Scan (PEDS) instrument, and at the school and individual levels using the National SRTS Center's teacher tallies and parent surveys. PEDS scores were developed to rate conduciveness to walking/bicycling of proposed SRTS routes. Sites' scores were compared with the percentage of students who walk/bike to school. Five schools in Louisiana were evaluated. Overall, more students walked (range: 2.4-17.4%) than biked (range: 0.3-4.5%) to school with more students walking home than to school. Predictors of walking/biking to school include distance from school, speed of traffic, school encouragement, and if a student asked permission. Sites with the highest PEDS score had the highest percentage of students who walked/biked to school. There is a role and a need for the SRTS program. The environment and other factors influence biking and walking to school. © 2014, American School Health Association.

Exercise Training and Energy Expenditure following Weight Loss

PubMed Central

Hunter, Gary R.; Fisher, Gordon; Neumeier, William H.; Carter, Stephen J.; Plaisance, Eric P.

2015-01-01

Purpose Determine the effects of aerobic or resistance training on activity related energy expenditure (AEE, kcal/d) and physical activity index (ARTE) following weight loss. It was hypothesized that weight loss without exercise training would be accompanied by a decrease in AEE, ARTE, and non-training physical activity energy expenditure (NEAT) and that exercise training would prevent decreases in free living energy expenditure. Methods 140 pre-menopausal women underwent an average of 25 pound weight loss during an 800 kcal/day diet of furnished food. One group aerobically trained 3 times/wk (40 min/d), another resistance trained 3 times/wk (10 exercises/2 sets x10 repetitions) and the third group did not exercise. DXA was used to measure body composition, indirect calorimetry to measure resting (REE) and walking energy expenditure, and doubly labeled water to measure total energy expenditure (TEE). AEE, ARTE, and non-training physical activity energy expenditure (NEAT) were calculated. Results TEE, REE, and NEAT all decreased following weight loss for the no exercise group, but not for the aerobic and resistance trainers. Only REE decreased in the two exercise groups. The resistance trainers increased ARTE. Heart rate and oxygen uptake while walking on the flat and up a grade were consistently related to TEE, AEE, NEAT, and ARTE. Conclusion Exercise training prevents a decrease in energy expenditure, including free living energy expenditure separate from the exercise training, following weight loss. Resistance training increased physical activity, while ease and economy in walking associates with increased TEE, AEE, NEAT, and ARTE. PMID:25606816

Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study.

PubMed

Louie, Dennis R; Eng, Janice J; Lam, Tania

2015-10-14

Powered robotic exoskeletons are an emerging technology of wearable orthoses that can be used as an assistive device to enable non-ambulatory individuals with spinal cord injury (SCI) to walk, or as a rehabilitation tool to improve walking ability in ambulatory individuals with SCI. No studies to date have systematically reviewed the literature on the efficacy of powered exoskeletons on restoring walking function. Our objective was to systematically review the literature to determine the gait speed attained by individuals with SCI when using a powered exoskeleton to walk, factors influencing this speed, and characteristics of studies involving a powered exoskeleton (e.g. inclusion criteria, screening, and training processes). A systematic search in computerized databases was conducted to identify articles that reported on walking outcomes when using a powered exoskeleton. Individual gait speed data from each study was extracted. Pearson correlations were performed between gait speed and 1) age, 2) years post-injury, 3) injury level, and 4) number of training sessions. Fifteen articles met inclusion criteria, 14 of which investigated the powered exoskeleton as an assistive device for non-ambulatory individuals and one which used it as a training intervention for ambulatory individuals with SCI. The mean gait speed attained by non-ambulatory participants (n = 84) while wearing a powered exoskeleton was 0.26 m/s, with the majority having a thoracic-level motor-complete injury. Twelve articles reported individual data for the non-ambulatory participants, from which a positive correlation was found between gait speed and 1) age (r = 0.27, 95 % CI 0.02-0.48, p = 0.03, 63 participants), 2) injury level (r = 0.27, 95 % CI 0.02-0.48, p = 0.03, 63 participants), and 3) training sessions (r = 0.41, 95 % CI 0.16-0.61, p = 0.002, 55 participants). In conclusion, powered exoskeletons can provide non-ambulatory individuals with thoracic-level motor-complete SCI the ability to walk at modest speeds. This speed is related to level of injury as well as training time.

Cognitive-Based Interventions to Improve Mobility: A Systematic Review and Meta-analysis.

PubMed

Marusic, Uros; Verghese, Joe; Mahoney, Jeannette R

2018-06-01

A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance. A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018. Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included. Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions. Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95% confidence interval (CI) 0.13 to 0.81, P = .007, I 2  = 15.85%], but not simple gait (ES = 0.35, 95% CI -0.01 to 0.71, P = .057, I 2  = 57.32%). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P = .067). This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Individuals with severely impaired vision can learn useful orientation and mobility skills in virtual streets and can use them to improve real street safety.

PubMed

Bowman, Ellen Lambert; Liu, Lei

2017-01-01

Virtual reality has great potential in training road safety skills to individuals with low vision but the feasibility of such training has not been demonstrated. We tested the hypotheses that low vision individuals could learn useful skills in virtual streets and could apply them to improve real street safety. Twelve participants, whose vision was too poor to use the pedestrian signals were taught by a certified orientation and mobility specialist to determine the safest time to cross the street using the visual and auditory signals made by the start of previously stopped cars at a traffic-light controlled street intersection. Four participants were trained in real streets and eight in virtual streets presented on 3 projection screens. The crossing timing of all participants was evaluated in real streets before and after training. The participants were instructed to say "GO" at the time when they felt the safest to cross the street. A safety score was derived to quantify the GO calls based on its occurrence in the pedestrian phase (when the pedestrian sign did not show DON'T WALK). Before training, > 50% of the GO calls from all participants fell in the DON'T WALK phase of the traffic cycle and thus were totally unsafe. 20% of the GO calls fell in the latter half of the pedestrian phase. These calls were unsafe because one initiated crossing this late might not have sufficient time to walk across the street. After training, 90% of the GO calls fell in the early half of the pedestrian phase. These calls were safer because one initiated crossing in the pedestrian phase and had at least half of the pedestrian phase for walking across. Similar safety changes occurred in both virtual street and real street trained participants. An ANOVA showed a significant increase of the safety scores after training and there was no difference in this safety improvement between the virtual street and real street trained participants. This study demonstrated that virtual reality-based orientation and mobility training could be as efficient as real street training in improving street safety in individuals with severely impaired vision.

Pilot Evaluation of a Walking School Bus Program in a Low-Income Urban Community

USDA-ARS?s Scientific Manuscript database

To evaluate the impact of a walking school bus (WSB) program on the proportion of students walking to school in a low-income, urban neighborhood, we conducted a controlled, quasi-experimental trial in urban, socioeconomically disadvantaged, public elementary schools (one intervention and two control...

Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability.

PubMed

Sandroff, Brian M; Bollaert, Rachel E; Pilutti, Lara A; Peterson, Melissa L; Baynard, Tracy; Fernhall, Bo; McAuley, Edward; Motl, Robert W

2017-10-01

Mobility disability is a common, debilitating feature of multiple sclerosis (MS). Exercise training has been identified as an approach to improve MS-related mobility disability. However, exercise randomized controlled trials (RCTs) on mobility in MS have generally not selectively targeted those with the onset of irreversible mobility disability. The current multi-site RCT compared the efficacy of 6-months of supervised, multimodal exercise training with an active control condition for improving mobility, gait, physical fitness, and cognitive outcomes in persons with substantial MS-related mobility disability. 83 participants with substantial MS-related mobility disability underwent initial mobility, gait, fitness, and cognitive processing speed assessments and were randomly assigned to 6-months of supervised multimodal (progressive aerobic, resistance, and balance) exercise training (intervention condition) or stretching-and-toning activities (control condition). Participants completed the same outcome assessments halfway through and immediately following the 6-month study period. There were statistically significant improvements in six-minute walk performance (F(2158)=3.12, p=0.05, η p 2 =0.04), peak power output (F(2150)=8.16, p<0.01, η p 2 =0.10), and Paced Auditory Serial Addition Test performance (F(2162)=4.67, p=0.01, η p 2 =0.05), but not gait outcomes, for those who underwent the intervention compared with those who underwent the control condition. This RCT provides novel, preliminary evidence that multimodal exercise training may improve endurance walking performance and cognitive processing speed, perhaps based on improvements in cardiorespiratory capacity, in persons with MS with substantial mobility disability. This is critical for informing the development of multi-site exercise rehabilitation programs in larger samples of persons with MS-related mobility disability. Copyright © 2017 Elsevier Inc. All rights reserved.

Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes.

PubMed

Hornby, T George; Holleran, Carey L; Leddy, Abigail L; Hennessy, Patrick; Leech, Kristan A; Connolly, Mark; Moore, Jennifer L; Straube, Donald; Lovell, Linda; Roth, Elliot

2015-01-01

Optimal physical therapy strategies to maximize locomotor function in patients early poststroke are not well established. Emerging data indicate that substantial amounts of task-specific stepping practice may improve locomotor function, although stepping practice provided during inpatient rehabilitation is limited (<300 steps/session). The purpose of this investigation was to determine the feasibility of providing focused stepping training to patients early poststroke and its potential association with walking and other mobility outcomes. Daily stepping was recorded on 201 patients <6 months poststroke (80% < 1 month) during inpatient rehabilitation following implementation of a focused training program to maximize stepping practice during clinical physical therapy sessions. Primary outcomes included distance and physical assistance required during a 6-minute walk test (6MWT) and balance using the Berg Balance Scale (BBS). Retrospective data analysis included multiple regression techniques to evaluate the contributions of demographics, training activities, and baseline motor function to primary outcomes at discharge. Median stepping activity recorded from patients was 1516 steps/d, which is 5 to 6 times greater than that typically observed. The number of steps per day was positively correlated with both discharge 6MWT and BBS and improvements from baseline (changes; r = 0.40-0.87), independently contributing 10% to 31% of the total variance. Stepping activity also predicted level of assistance at discharge and discharge location (home vs other facility). Providing focused, repeated stepping training was feasible early poststroke during inpatient rehabilitation and was related to mobility outcomes. Further research is required to evaluate the effectiveness of these training strategies on short- or long-term mobility outcomes as compared with conventional interventions. © The Author(s) 2015.

Myocardial work during endurance training and resistance training: a daily comparison, from workout session 1 through completion of cardiac rehabilitation

PubMed Central

Hubbard, Matthew; McCullough-Shock, Tiffany; Simms, Kay; Cheng, Dunlei; Hartman, Julie; Strauss, Danielle; Anderson, Valerie; Lawrence, Anne; Malorzo, Emily

2010-01-01

Patients in cardiac rehabilitation are typically advised to complete a period of supervised endurance training before beginning resistance training. In this study, however, we compared the peak rate-pressure product (RPP, a calculated indicator of myocardial work) of patients during two types of exercise—treadmill walking and chest press—from workout session 1 through completion of cardiac rehabilitation. Twenty-one patients (4 women and 17 men, aged 35 to 70 years) were enrolled in the study; they were referred for cardiac rehabilitation after myocardial infarction, percutaneous coronary intervention, or both. The participants did treadmill walking and chest press exercises during each workout session. Peak values for heart rate (HR) and systolic blood pressure (SBP) were recorded, and the peak RPP was calculated (peak HR ⊠ peak SBP). Paired t tests were used to compare the data collected during the two types of exercise across 19 workout sessions. The mean peak values for HR, SBP, and RPP were lower during resistance training than during endurance training; the differences were statistically significant (P < 0.05), with only one exception (the SBP for session 1). Across all 19 workout sessions, the participants performed more myocardial work, as indicated by the peak RPP, during treadmill walking than during the chest press. PMID:20396420