Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case–control study

Background: Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups. Methods: Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables. Results: There were significant effects (P <0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking. Conclusions: Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems

The impact of different mobile phone tasks on gait behaviour in healthy young adults

Introduction: The aim of this study was to examine the impact of different mobile phone tasks on gait behaviour in healthy young adults. Methods: An experimental design was used in this study. Twenty-five participants, 7 males and 18 females, aged 22.56 2.45 years completed 5 tasks whilst walking. The conditions consisted of no task, calling, playing a game, listening to music, texting, and watching a video. Gait behaviour was captured using a Zebris Force Distribution Measurement (FDM) system, and 6 trials were recorded under each condition. Temporo-spatial gait variables included step length, step time, stride length, stride time, step width, cadence, velocity, foot rotation angle, % stance phase, % loading response, % single support time, % pre-swing, % swing phase, and % double support time. In addition, the level of confidence during walking was assessed using an 11 point scale. Results: Repeated measure ANOVAs with post hoc pairwise comparisons revealed that mobile phone usage altered all temporo-spatial variables significantly (p <0.05), except for foot rotation angle. Texting and watching a video were the most notable changes, with listening to music showing no difference when compared to no task. Conclusion: Mobile phone usage modified gait behaviour to such a degree that it may compromise safety by dividing an individual’s attention, with the lowest level of confidence being while watching video and texting. Although the potential danger of the use of mobile phones while walking is being discussed worldwide, a clear policy still does not exist, and individuals using mobile phones, in particular for watching video and texting while walking, should be made more aware of the risk of injury

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus

Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Methods: Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-hour post-tap tests which were compared using Paired t-tests, Cohen’s d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Results: Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Conclusions: Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables

The Vertical Ground Reaction Force and Temporal-Spatial Parameters of Transfemoral Amputees Wearing Three Prosthetic Knee Joints Available in Thailand: a Pilot Study

Objective: To examine the temporal-spatial characteristics of transfemoral amputees using three prosthetic knees available in Thailand. In addition, the estimated vertical Ground Reaction Force (vGRF) was explored, in particular the graphical differences in the M-shape of the vGRF pattern amongst each of the knees and the sound limb. Methods: Three transfemoral amputees were fitted with three different prosthetic knee joints (Chulalongkorn University (CU) Polycentric Knee Joint, Prosthesis Foundation Knee, Otto Bock 3R20) and performed walking trials while the vGRF and temporal-spatial parameters were collected for all participants. Results: Similarities existed amongst GRF metrics across all prosthetic knees. Stance and swing time in the CU Polycentric Knee Joint was similar to that of the sound limb. Walking speeds were highest in the Otto Bock 3R20 and lowest in the Prosthesis Foundation Knee. Conclusion: This preliminary pilot testing revealed similarities amongst all three prosthetic knees. Future research with more participants and additional analysis could further elucidate characteristics of these prosthetic knees

Effect of sound on standing postural stability in the elderly with and without knee osteoarthritis

The aim of the study was to investigate the influence of sound on standing postural control in the elderly with and without knee osteoarthritis (knee-OA). Methods: Twenty-six elderly with knee-OA and 26 elderly without knee-OA who matched the age and height participated in this study. The standing postural stability was assessed by the 3D motion analysis system. Four testing conditions of the combination of sound (no sound and white noise sound) and surface (firm and soft surfaces) were tested three times with eyes closed for 30 sec. Postural stability variables included the standard deviation and velocity of the centre of pressure, the total body centre of mass, and centre of the head along the antero-posterior (AP) and medio-lateral (ML) directions. Results: Statistical significant reductions of all variables along ML direction were found in the elderly without a knee-OA in the presence of sound during standing on a firm surface. No significant effect of sound was found in the elderly with the knee-OA during standing on a firm surface. In the standing on a soft surface, both groups demonstrated no significant effect of sound on all postural stability variables. Conclusions: Application of sound improved the standing postural stability in the frontal plane for the elderly without knee-OA. However, the effect of sound was limited in standing on a soft surface for both elderly with and without knee-OA

The effect of a home-based stretching exercise on the ground reaction force generation and absorption during walking in individuals with plantar fasciitis

Objectives: This study aimed to investigate the effect of a home-based stretching exercise program in individuals with plantar fasciitis (PF), and to compare its effect on ground reaction force (GRF)-time variables between the mild, moderate, and severe pain subgroups as well as between before and after in each subgroup. Design: A single cohort with pre-and post-test design. Interventions: Twenty individuals with PF received 3 weeks of home-based stretching exercise program for calf muscles and plantar fascia. The data were compared between before and after exercise in a whole number of participants and were compared among the mild (n = 7), moderate (n = 7), and severe (n = 6) pain subgroups. Main Outcome Measures: Force data were collected during walking using two force plates. GRF-time variables included the force and time at; first peak (F1 and TF1), valley (F2 and TF2), second peak (F3 and TF3) for the vertical forces, peak breaking (F4 and TF4) and propulsive (F5 and TF5) forces, first peak (F6 and TF6) and second peak lateral (F7 and TF7) forces. Additionally, worst pain was assessed using the visual analog scale. Results: Significant reductions were seen in F2, TF2, TF3, TF5 and worst pain after exercise in individuals with PF (P <0.05). No differences were seen between the three subgroups. For the within subgroup analysis, only the mild subgroup showed significant changes in F2, TF2, F4, TF6, and TF7 after exercise (P <0.05). Conclusion: A home-based stretching exercise program was effective in reducing pain and some GRF-time variables, with the most noticeable response seen in the mild subgroup

Alteration of the multi-segment foot motion during gait in individuals with plantar fasciitis: a matched case-control study

The objective of this study was to compare the ground reaction forces (GRFs) and the multi-segment foot motion between individuals with plantar fasciitis (PF) and healthy controls. Methods: Twenty-one individuals with PF and 21 matched-case healthy controls who passed the criteria participated in the study. Gait data were assessed during their self-selected comfortable speeds by the 3D motion analysis system. The multi-segment foot motions were determined by the Oxford Foot Model. Outcome measures included the vertical and antero-posterior ground reaction forces (GRFs) and the multi-segment foot motions [the dorsiflexion (DF), plantarflexion (PF), inversion (Inv), eversion (Eve), adduction (Add), and abduction (Abd) peak angles for the forefoot with respect to hindfoot (FFHF) and the DF, PF, Inv, Eve, internal rotation (IR), and external rotation (ER) peak angles for the hindfoot with respect to tibia (HFTB) as well as their ranges (R)]. Results: Comparisons between individuals with PF and healthy controls showed no significant differences in any of the GRFs. Significant reductions were found in the FFHF-DF, FFHF-DF-R, FFHF-Inv, and HFTB-Inv/Eve-R in individuals with PF. In addition, there were tendencies of the increased angles of the FFHF-PF, HFTB-DF, HFTB-Inv, and HFTB-ER, but not significantly for individuals with PF, compared to healthy controls. Conclusions: Adaptations of the intra-foot motion showed the reduction of some angles but no change for the GRFs in individuals with PF compared to the healthy controls when both groups walked at a similar gait speed

Does the Global Rating Scale Correlate with Standard Clinical Outcomes in Chronic Individuals with Stroke?

Several well-accepted stroke assessment scales have been developed for use in clinical settings such as Stroke Impact Scale (SIS), Fugl-Meyer Assessment for the Upper Extremity and Lower Extremity (FMA-UE and FMA-LE), Berg Balance Score (BBS), Modified Ranking Scale (MRS), and the global rating of change scale (GROC). However, clinical outcomes were assessed by patient self-evaluation and physiotherapists, responsiveness and discrimination of high and low disability in the context of functional recovery have not yet been confirmed. The purpose of this study was to 1) compare the Stroke Impact Scale (SIS) and clinical outcomes between the baseline and after the 12-week physical therapy treatment program and 2) to investigate the correlation between the global rating of change (GROC) with the SIS and other clinical outcomes in individuals with chronic stroke. Participants underwent physical therapy at least twice a week. The SIS and clinical outcome measures including Fugl-Meyer Assessment for the Upper Extremity and Lower Extremity (FMA-UE and FMA-LE), Berg Balance Score (BBS), Modified Ranking Scale (MRS), gait speed, and the GROC were measured at the baseline and after the 12-week physical therapy treatment. The data analysis examined the differences between the SIS and all clinical outcomes and between the baseline and after the 12-week physical therapy treatment. Then, the authors explored the correlation between the GROC and SIS in each domain. The authors also explored the correlation between the GROC and changes in the other clinical outcomes after the 12-week physical therapy treatment. The results showed that there was a significant difference in only the SIS score between the baseline and after 12-week of physical therapy treatment in the domains of strength, emotion, ADL, mobility, social participation, and global recovery. Besides, the GROC score showed a median score of +3.25 (3, 4) after the 12-week of physical therapy treatment. Finally, there was a fair correlation between the GROC and the SIS. Therefore, the differences between the baseline and after the 12-week of physical therapy treatment were explored in the SIS, and the GROC scale could be applied to suit the needs of physiotherapists or clinicians when time and difficulties in other methods of assessment exist