Correlation between gait parameters and balance in stroke hemiplegic patients / 中国康复理论与实践

@#Objective To investigate the relationship between gait spatiotemporal parameters and balance function in stroke hemiplegic patients. Methods From September, 2018 to March, 2020, 76 stroke hemiplegic patients (38 in Brunnstrom Ⅳ and V, respectively) were assessed balance function with Active Balancer EAB-100 and Star Excursion Balance Test (SEBT), and gait parameters of speed, cadence and asymmetry, named step length asymmetry ratio (SLA), swing time asymmetry ratio (SWTA), stance time asymmetry ratio (STA), maximum flexion angle ratio (MFA) of hip and knee. The correlation among gait parameters and balance function was analysed. Results The balance and gait parameters were better in those in Brunnstrom V than in Brunnstrom Ⅳ (|t| > 2.268, P < 0.05). The speed and cadence correlated with the most balance indexes (|r| > 0.335, P < 0.05). SLA correlated with SEBT in Brunnstrom Ⅳ patients (r = -0.467~-0.613, P < 0.01), while it correlated with medial-lateral (M-L) stability limits in Brunnstrom V patients (r = -0.356, P = 0.028). SWTA correlated with stability limit of Anterior-Posterior (A-P) (r = -0.335, P = 0.040) and M-L (r = 0.510, P = 0.001), and most of SEBT (r = -0.330~ -0.445, P < 0.05) in Brunnstrom Ⅳ patients. MFA of hip and knee correlated with balance indexes in Brunnstrom Ⅳ patients (|r| > 0.326, P < 0.05), while MFA of knee correlated with most balance indexes in Brunnstrom V patients (r > 0.329, P < 0.05), and MFA of hip correlated with A-P stability limit (r = 0.369, P = 0.023). Conclusion Both speed and cadence of steps can well respond to the balance function in stroke hemiplegic patients. For the asymmetry, it is related with balance in patients with poorer recovery.

Equilíbrio e força de membros inferiores correlacionam-se com velocidade de marcha em pacientes com AVC: um estudo observacional / Balance and lower limb strength correlate with gait speed in stroke patients: an observational study

INTRODUÇÃO: A marcha e o equilíbrio são frequentemente comprometidos após lesões cerebrais como o Acidente Vascular Cerebral (AVC). OBJETIVO: Correlacionar a força dos membros inferiores e o equilíbrio em apoio unipodal no membro parético com a velocidade de marcha em pacientes com AVC. MÉTODOS: Estudo do tipo observacional transversal. Indivíduos de ambos os sexos com diagnóstico de AVC atendidos no Ambulatório de Neurovascular do Hospital de Clínicas de Porto Alegre, que conseguissem permanecer em ortostase por dois minutos sem auxílio e com marcha domiciliar com ou sem auxílio de dispositivos de marcha, foram avaliados quanto a força muscular de MsIs, por meio do Teste de Sentar e Levantar em 30 segundos (TSL30s); avaliação do equilíbrio pelo Teste de Apoio Unipodal (AU) e da velocidade da marcha pelo Teste de Caminhada de 10 metros (TC10m) com auxílio de um acelerômetro fixado na região de L5. RESULTADOS: Dos trinta e quatro indivíduos avaliados, 67,6% eram do sexo feminino, com média de idade de 60,5 (± 13,6) anos. A velocidade de marcha confortável média foi 1,01 ± 0,31 m/s, a média no TSL30s foi 9 ± 2,94 repetições e o tempo médio de apoio no membro inferior acometido foi de 4,11 ± 10,43 segundos. Houve correlação dos valores no TC10m com o tempo de permanência no lado acometido (r=0,563 p<0,001) e com o número de repetições no TSL30s (r=0,667 p<0,001). CONCLUSÃO: Quanto maior a força muscular dos MsIs e o equilíbrio em apoio unipodal sobre o membro inferior acometido, maior a velocidade de marcha nos pacientes com AVC.

BACKGROUND: Gait and balance are often compromised after brain injuries such as stroke. OBJECTIVE: To correlate the lower limb muscle strength walking speed, and balance in unipedal support on a paretic limb with gait speed in stroke patients. METHODS: This study employed a correlational design. Individuals of both genders with a stroke diagnosis were seen at the Neurovascular Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, Brazil, who were able to remain in orthostasis for two minutes without assistance and with walking at home with or without the aid of walking devices. The Sit-to-stand test for 30 seconds (STS 30s) was used to examine muscle strength of lower limbs; the balance was measured using the Unipedal Support Test (UST) and walking speed with 10 Meter Walk Test (10MWT) and used an accelerometer around the waist of the subject. RESULTS: A total of 34 subjects were evaluated, 67.6% female and mean age 60.5 (± 13.6) years. The average comfortable walking speed was 1.01 ± 0.31 m/s, the average in the STS 30s was 9 ± 2.94 repetitions, and the average support time on the affected lower limb was 4.11 ± 10.43 seconds. In addition, there was a correlation between the values in the 10MWT and the length of stay on the affected side (r=0.563 p<0.001) and with the number of repetitions in the STS 30s (r=0.667 p<0.001). CONCLUSION: The greater the muscle strength of the lower limbs and the balance in unipedal support on the affected lower limb, the greater the gait speed in stroke patients.

Advance in Rhythmic Auditory Stimulation to Improve Walking Function in Patients with Hemiplegia after Stroke (review) / 中国康复理论与实践

@#Through providing rhythmic stimulation to movement center, rhythmic auditory stimulation (RAS) may encourage hemiplegic patients to adjust movement pattern and external rhythm in time to improve the walking function after stroke. As an emerging intervention to treat the hemiplegic patients after stroke, RAS could effectively improve temporospatial gait parameters (gait velocity, stride length, cadence, and symmetry, etc.), joint movement pattern (angle of pelvis anterior tilt, and peak angle of knee flexion in mid-swing, etc.) and balance, which may be related to rhythmic entrainment movement system and the theory of auditory-movement synchronization. Simultaneously, frequency and dosage of RAS and the patient's lesions all have effect on the outcome of intervention.

Validity of Functional Gait Assessment in Patients with Parkinson's Disease / 中国康复理论与实践

@#Objective To investigate the construct and concurrent validity of the Functional Gait Assessment (FGA) as the measure for balance and gait during walking in Parkinson's disease patients. Methods From March to December, 2011, 121 patients with Parkinson's disease (mean aged 61.9 years) were evaluated with FGA by one rater, as well as the other scales for balance and gait, such as Berg Balance Scale, Functional Ambulation Category, Timed Up and Go Test, Activities-specific Balance Confidence Scale, Movement Disorders Society revision of the Unified Parkinson's Disease Rating Scale part 3, modified Barthel Index, maximum walking speed and Modified Hoehn and Yahr Scale. Principal Component Analysis was used to determine construct validity. Spearman correlation coefficients between the FGA and other measures were used to determine concurrent validity. Results One common factor was extracted, which cumulatively explained 64.0% of the total variance. The FGA correlated moderately with the other measures (r = 0.57-0.85). Conclusion FGA is good in validity for Parkinson's disease patients.

Balance Deficit and Brain Connectivity in Children with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE: We aimed to assess disturbances in postural and gait balance and functional connectivity within the brain regions controlling balance in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Thirteen children with ADHD and 13 age- and sex-matched controls were recruited. Gait balance was assessed by the difference in the center of pressure (COP) between the left and right foot, as well as the difference in plantar pressure between the left and right foot during gait. Neuroimaging data were acquired using a 3.0 Tesla MRI scanner. Functional connectivity between the vermis of the cerebellum and all other brain regionswas assessed. RESULTS: The difference in plantar pressure between the left foot and right foot in the ADHD group was greater than that observed in the control group. The average COP jerk score of the right foot in the ADHD group was higher than that observed in the control group. A higher functional connectivity between the cerebellum and the right middle frontal gyrus (premotor cortex) and medial frontal gyrus (cingulate gyrus) was observed in the control group relative to the ADHD group. In the ADHD group, the difference in plantar pressure between the left and right foot was also negatively correlated with the beta-value within the middle frontal gyrus. CONCLUSION: Children with ADHD had disturbance of balance as assessed by plantar pressure. Decreased brain connectivity from the cerebellum to the premotor cortex and anterior cingulate was associated with disturbances of posture and balance in children with ADHD.

Advance in Cognitive and Postural Control Dual-task in Falls of Older People (review) / 中国康复理论与实践

@#Dual-task diagram focuses on the interaction between cognition and motor control, and has been applied in falls predictor and training in old people. It was found that dual-task diagram is a more sensitive and useful method than gait test to predict the risk of falls in the older people, especially for those with central nervous system disease. The dual-task training can improve the cognitive and physical abilities of the older adults, but it is argued that combined cognitive and physical exercise is more beneficial than either one individually.