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

Background: 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.Methods: 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 bethe 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 clinicalmeasures 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.Discussion: 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.Trial registration: Netherlands Trial Register NTR4030. Registered on 11 June 2013, amendment filed on 17 June 2016.Keywords: Exercise, Rehabilitation, Stroke, Therapy, Walking adaptability, Walking spee

Comparison of muscle strength, sprint power and aerobic capacity in adults with and without cerebral palsy

Objective: To compare: (i) muscle strength, sprint power and maximal aerobic capacity; and (ii) the correlations between these variables in adults with and without cerebral palsy. Design: Cross-sectional study. Subjects: Twenty adults with and 24 without cerebral palsy. Methods: Isometric and isokinetic knee extension strength, sprint power (mean power over the 30s (P30)), peak aerobic power output (POpeak) and oxygen uptake (VO2peak) were determined. Regression analysis was used to investigate correlations between parameters. Results: Adults with cerebral palsy had significantly lower strength (53-69%) and P30 (67%) than adults without cerebral palsy, but similar POpeak and VO2peak. In adults without cerebral palsy the only significant correlations, albeit weak, were between P30 and isometric (R-2=0.34) or isokinetic strength (R-2=0.20), as well as the correlation between P30 and VOpeak (R-2=0.26) or POpeak (R-2=0.36). Stronger correlations were found in the group with cerebral palsy between P30 and isometric (R-2=0.52) and isokinetic strength (R-2=0.71) and between P30 and VOpeak (R-2=0.75) or POpeak (R-2=0.94). Conclusion: In contrast to aerobic capacity, strength and P30 are reduced in (active) people with cerebral palsy. Stronger correlations were found between strength, P30 and POpeak in adults with cerebral palsy. Therefore, muscle strength may be the limiting factor in adults with cerebral palsy for activities involving the lower extremities, such as cycling

Accuracy of heart rate measurement by the Fitbit Charge 2 during wheelchair activities in people with spinal cord injury: instrument validation study

Computer Science

Glenohumeral contact forces and muscle forces evaluated in wheelchair-related activities of daily living in able-bodied subjects versus subjects with paraplegia and tetraplegia

Objective: To estimate the differences in glenohumeral contact forces and shoulder muscle forces between able-bodied subjects and subjects with paraplegia and tetraplegia during wheelchair-related activities of daily living (ADLs). Design: Kinematics and external forces were measured during wheelchair ADLs (level propulsion, weight-relief lifting, reaching) and processed by using an inverse dynamics 3-dimensional biomechanical model. Setting: Biomechanics laboratory. Participants: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia (N=17). Interventions: Not applicable. Main Outcome Measures: Glenohumeral contact forces and shoulder muscle forces. Results: Peak contact forces were significantly higher for weight-relief lifting compared with reaching and level propulsion (P Conclusions: Glenohumeral contact forces were significantly higher for weight-relief lifting and highest over the 3 tasks for the tetraplegia group. Without taking paralysis into account, more muscle force was estimated for the subjects with tetraplegia during weight-relief lifting. (c) 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels

Objective: To investigate the effects of low-intensity wheelchair training on wheelchair-specific fitness, wheelchair skill performance and physical activity levels in inactive people with long-term spinal cord injury. Design: Randomized controlled trial. Participants: Inactive manual wheelchair users with spinal cord injury for at least 10 years (n = 29), allocated to exercise (n = 14) or no exercise. Methods: The 16-week training consisted of wheelchair treadmill-propulsion at 30-40% heart rate reserve or equivalent in terms of rate of perceived exertion, twice a week, for 30 min per session. Wheelchair-specific fitness was determined as the highest 5-s power output over 15-m overground wheelchair sprinting (P5-15m), isometric push-force, submaximal fitness and peak aerobic work capacity. Skill was determined as performance time, ability and strain scores over a wheelchair circuit. Activity was determined using a questionnaire and an odometer. Results: Significant training effects appeared only in P5-15m (exercise vs control: mean +2.0 W vs -0.7 W, p = 0.017, ru=0.65). Conclusion: The low-intensity wheelchair training appeared insufficient for substantial effects in the sample of inactive people with long-term spinal cord injury, presumably in part owing to a too-low exercise frequency. Effective yet feasible and sustainable training, as well as other physical activity programmes remain to be developed for inactive people with long-term spinal cord injury. Key words: activities of daily living; paraplegia; physical activity; physical fitness; spinal cord injuries; tetraplegia; rehabilitation; wheelchairs