Influence of a walking aid on temporal and spatial parameters of gait in healthy adults

This is the post-print version of the final paper published in PM&R. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2014 Elsevier B.V.Objective - To determine the effect of using a walking aid on temporal and spatial parameters of gait when used for balance versus support on the dominant and nondominant hand side. Design - Repeated measures observational study design. Setting - University gymnasium. Participants - Twenty-seven healthy male and female adults of mean ± standard deviation age 44.74 ± 10.00 years. Methods - Five walking conditions (C) were completed by all participants on the GAITRite pressure mat. Normal walking (C1), walking with a cane in the dominant hand (C2) and nondominant hand (C3) as if using for balance, walking with a cane in the dominant hand (C4) and nondominant hand (C5) while allowing approximately 10% of the body weight through the cane. Main Outcome Measurements - Temporal measurements (swing time, stance time, single limb support time, double limb support time) as percentage of a gait cycle and the base of support for the left and the right foot for all 5 walking conditions. Results - A significant difference (P < .001) was observed between C1, C2, and C3 in percentage swing time and percentage stance time of the ipsilateral side, and in percentage single limb support time of the contralateral side. The double limb support time was significantly different (P ≤ .04) for both ipsilateral and contralateral sides. Comparisons among C1, C4, and C5 demonstrated significance (P < .001) for all variables. Post hoc analysis showed significance between C1 and C4, and C1 and C5 for all variables except percentage stance time of the ipsilateral side and percentage single limb support of the contralateral side. Conclusions - In healthy adults, use of a cane for balance modifies swing and stance parameters of the ipsilateral side and does not affect the base of support formed by the feet. When used for support, the cane alters the swing and stance parameters, and also the base of support formed by the feet

An investigation of dynamic balance and postural control in persons with below-knee amputation due to a dysvascular condition

Background and aim: Lower limb amputation (LLA) disrupts the typical functioning of an individual with the loss of normal ankle joint, surrounding musculature and associated sensory-motor loop. Although LLA is a peripheral condition, considerable sensorimotor reorganisation is required for relearning of effective postural control subsequent to the amputation. The ability to relearn postural control is affected by various factors such as ageing and disease co-morbidities. However there is insufficient understanding of patient-centred problems due to the fact that postural control research in persons with LLA is complicated by differing levels of amputation, the presence of peripheral vascular disease, age and other confounding factors. Therefore the overall aim of thesis was to explore and compare dynamic balance performance in persons with a dysvascular and traumatic below-knee amputation and, with age matched able-bodied and, able-bodied dysvascular control subjects. Methods and results: The thesis comprises three projects: a systematic review of instrumented measurement of balance in persons with LLA followed by two individual studies in persons with below-knee amputation. The systematic review identified the methodological issues in postural control research in persons with LLA and it was recognised that the dynamic and functional balance needs further attention in persons with LLA. The findings from the systematic review informed the methods used in Study 1 which was undertaken to examine the psychometric properties (feasibility, reliability and validity) of selective tasks in below-knee amputees. In Study 1, 15 persons with a below-knee amputation (8 traumatic amputations and 7 dysvascular amputations) who were 60 years and older completed the Sensory Organization Test (SOT), Sit to Stand (STS), Step Quick Turn (SQT) and the Step Up and Over (SUO) using the NeuroCom® Balance Manager on two occasions approximately two weeks apart. The SOT and SQT tests were determined to be feasible in persons with a below-knee amputation and their measures demonstrated acceptable test-retest reliability (ICC ≥ 0.79, SEM ≤ 10% mean) and concurrent validity (rs≥ 0.56). An exploratory analysis that compared the balance performance of the traumatic and dysvascular amputees with these measures identified a difference in postural strategy in the SOT for conditions 2, 4 and 6 (p< 0.05) and in the Turn Time and Turn Sway variables of the SQT (p<0.05). In Study 2, 19 persons with a below-knee amputation (9 traumatic and 10 dysvascular) and 17 able-bodied control participants (9 with and 8 without dysvascular condition) completed the SOT and three tasks that simulated the turning behaviour. A significant difference was observed in SOT between the dysvascular amputees and able-bodied participants in conditions 1 to 4 (p< 0.05) and between traumatic amputees and able-bodied in conditions 1, 3 and 4 (p<0.05). Although no significant difference was observed between the dysvascular and traumatic amputation groups in centre of pressure measures, a difference was observed in the average ankle muscle activity and ankle co-contraction index of condition 5 (p<0.05). Also, significant differences were observed in the co-contraction index between traumatic amputees and able-bodied group in conditions 2 and 4. Of the three tasks (trunk rotation, weight shifting, shifting and rotation of the trunk) that simulated the turning behaviour, a significant difference was observed between the dysvascular amputees and able-bodied group in the execution and stabilisation phases of trunk rotation and weight shifting (p<0.05) to the prosthetic side. Conclusion: The results suggest that the persons with a dysvascular amputation employ a strategy that is different to that of persons with a traumatic amputation when challenged with altered visual and somatosensory input. Additionally the results also suggest that the dysvascular amputees have more difficulty in performing voluntary functional tasks to the prosthetic side than persons with the traumatic amputation. While these investigations do not support a deficiency in dynamic balance performance in dysvascular amputees, it proposes that the dysvascular amputees employ a strategy different to that of their counterparts with a traumatic amputation. The traditional rehabilitation strategies that are common to all amputees may not be efficacious for persons with a dysvascular amputation. A more tailored approach with multisensory integration and a focussed functional rehabilitation is needed for the effective outcome in persons with a dysvascular amputation

Perspectives of Participants With Rotator Cuff-Related Pain to a Neuroscience-Informed Pain Education Session: An Exploratory Mixed Method Study

Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session. Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach. Results: There were two over-arching key themes: firstly, ‘Participants’ Perspectives’ of the session generated four themes: Improved understanding of ‘the whole’; Mindful self-awareness; Taking charge; “The pain is still there”. Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, ‘Participants’ Recommendations’, had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education. Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain

Inter-tester reliability of non-invasive technique for measurement of innominate motion

a b s t r a c t Although the complex anatomical orientation and position of the sacroiliac joints (SIJ) has rendered their 3D kinematic evaluation difficult, recent techniques of palpationedigitization of pelvic landmarks using electromagnetic tracking device have been able to accurately and non-invasively quantify the subtle SIJ kinematics. While this technique demonstrates radiographic validity and high test-retest reliability, it is yet to be assessed with regards to inter-tester and trial-to-trial reliability. A single-group repeated measure design using 4 testers was conducted to evaluate the inter-tester and trial-to-trial reliability of palpationedigitization technique for innominate vector length measurements using the Polhemus electromagnetic tracking device. Fourteen young, healthy adults between the ages of 18e40 years participated in the study. The innominate vector length was calculated from 3D co-ordinates of palpated and digitized pelvic landmarks in two test positions of hip. A sensitivity analysis was conducted to determine how palpationedigitization errors for pelvic landmarks impacts on innominate angle calculation. Reliability indexes of Intraclass correlation coefficient (ICC) (!0.97) and Standard error of measurement (SEM) ( 2.02 mm) demonstrated very high inter-tester and trial-to-trial reliability and accuracy of palpationedigitization technique for innominate vector length measurements, irrespective of the two test positions. A higher consistency of measurements was obtained within-testers as compared to between testers, and sensitivity analysis demonstrated a negligible influence of palpationedigitization errors on the innominate angle measurements. The results support clinical and research utility of this technique for non-invasive kinematic evaluation of SIJ motion for this population. Further research on the use of this palpationedigitization technique in symptomatic population is warranted