Association of scoliosis with lower extremity alignments, muscle strengths, and foot characteristics and their alterations in adolescent idiopathic scoliosis.

BACKGROUND: The association between changes occurring in the spine and lower body parts is not well understood in adolescent idiopathic scoliosis (AIS). OBJECTIVES: The first aim of the study was to investigate the association of scoliosis with lower extremity (LE) alignments, foot characteristics, and muscle strengths in adolescents. Secondly, comparisons of the data among AIS with single and double curves and control groups were determined. METHODS: Thirty-one participants were recruited and classified into 3 groups; AIS with a single curve (n= 7), AIS with double curves (n= 14), and controls (n= 10). Association of the presence of scoliosis with LE alignments (Q and TC angles), LE muscle strengths (hip, knee, and ankle), and foot characteristics (arch indexes) were examined using the point biserial correlation, and the data among three groups were compared using the ANOVA. RESULTS: Scoliosis was associated with Q angle, arch indexes, and all LE muscle strengths except for hip extensors and ankle plantar flexors strengths. Comparisons among the three groups showed significant increases in LE alignments and foot characteristics in AIS. Almost all LE muscle strengths decreased in AIS, especially for the single curve group. CONCLUSIONS: Apart from spinal deformity, the AIS has changed in LE alignments, muscle strengths, and foot characteristics. Therapists should consider these associations and alterations for designing proper management.

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

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 spinal 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. 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-h 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. 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. 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 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 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 mild, moderate, and severe pain subgroups and between before and after in each subgroup. DESIGN: A single cohort with pre-and post-test. INTERVENTIONS: Twenty individuals with PF received 3 weeks of home-based stretching exercise for calf and plantar fascia. MAIN OUTCOME MEASURES: GRF-time variables included force and time at; first peak (F1 and TF1), valley (F2 and TF2), second peak (F3 and TF3) in vertical, 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 at before and after exercise. RESULTS: Significant reductions were seen in F2, TF2, TF3, TF5 and worst pain after exercise (P < 0.05) in individuals with PF. No differences were seen between three subgroups. For within subgroup analysis, only mild subgroup showed significant changes in F2, TF2, F4, TF6, and TF7 after exercise (P < 0.05). CONCLUSION: A home-based stretching exercise was effective in reducing pain and some GRF-time variables, with the most noticeable response seen in mild subgroup.

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.

Effect of progressive bridging exercise on weight-bearing during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke: A randomised controlled trial.

OBJECTIVE: To examine the effect of a progressive bridging exercise on force, time, and pressure during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke. DESIGN: A single-blinded randomised controlled trial. SETTING: Hospital. PARTICIPANTS: Forty-eight individuals with acute ischemic stroke, not at brainstem and cerebellum, randomly allocated to the intervention (n = 24) and control (n = 24) groups. Five participants dropped out during the 2-month follow-up, but they were in the intention-to-treat analysis. INTERVENTIONS: The intervention group undertook a 45-min conventional physiotherapy and a 30-min progressive bridging exercise. The control group received only the conventional exercise. MAIN MEASURES: Peak vertical ground reaction force, time to peak force, peak foot pressure, and regional peak foot pressure during the extension phase of sit-to-stand, and sitting-to-standing item of the Motor Assessment Scale were assessed before training, after 4-week training, and 2-month follow-up. RESULTS: The intervention group showed significantly (p < 0.001) less difference in peak vertical ground reaction force between feet during the extension phase of sit-to-stand than the control after 4-week training (mean ± standard deviation; intervention, 5.38 ± 3.99; control, 17.1 ± 10.3) and 2-month follow-up (intervention, 6.79 ± 3.84; control, 17.5 ± 9.89), and demonstrated significantly (p < 0.001) higher score in sit-to-stand than the control after training [mean (interquartile range); intervention, 5 (2-5); control, 2 (1-2)] and follow-up [intervention, 2 (2-5); control, 2 (1-2)]. Both groups demonstrated peak foot pressure on the medial and lateral heels, metatarsals, and hallux regions. CONCLUSION: Progressive bridging exercise improved symmetrical weight bearing during the extension phase of sit-to-stand, consequently enhanced sit-to-stand ability in individuals with stroke.

Effectiveness of Motor Imagery Combined with Structured Progressive Circuit Class Training on Functional Mobility in Post-Stroke Individuals: A Randomized Controlled Trial.

OBJECTIVE: To compare the effect of motor imagery combined with structured progressive circuit class therapy vs health education combined with structured progressive circuit class therapy on dynamic balance, endurance, and functional mobility in post-stroke individuals. DESIGN: Randomized controlled trial. METHODS: A total of 40 post-stroke individuals were randomly assigned to experimental and control groups. The experimental group was trained using motor imagery combined with structured progressive circuit class therapy, while the control group received health education combined with structured progressive circuit class therapy, 3 times a week for 4 weeks with an overall of 12 sessions. Outcomes included the step test for affected and unaffected limbs, the 6-Minute Walk Test, and the Timed Up and Go test. Assessments were performed at baseline, 2 weeks, and 4 weeks after the intervention Results: There were significant effects (p < 0.05) of: group on the step test for unaffected limb; of time on all outcomes; and of their interaction effect on the step test for affected limb, 6-Minute Walk Test, and Timed Up and Go test. Inter-group comparison showed significant differences (p < 0.05) in the step test for unaffected limb at 2 weeks after the intervention. At 4 weeks after the intervention, significant differences (p < 0.05) were found in the step test for affected and unaffected limbs and in the Timed Up and Go test. CONCLUSION: Motor imagery combined with structured progressive circuit class therapy was more effective on the step test, 6-Minute Walk Test, and Timed Up and Go test than training with structured progressive circuit class therapy alone. This suggest that that motor imagery should be incorporated into training programmes for restoring dynamic balance, endurance, and functional mobility in post-stroke individuals.

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial.

OBJECTIVE: To determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke. MATERIALS AND METHODS: Twenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up. RESULTS: The primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS. CONCLUSION: The combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.

Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients.

Action observation (AO) has been proved to be of benefit in several neurological conditions, but no study has previously been conducted in idiopathic normal pressure hydrocephalus (iNPH). OBJECTIVE: This study aimed to investigate the feasibility of AO in iNPH patients. METHODS: A single-group pretest-posttest design was conducted in twenty-seven iNPH patients. Gait and mobility parameters were assessed using the 2D gait measurement in the timed up and go (TUG) test for two trials before and after immediate AO training. The outcomes included step length and time, stride length and time, cadence, gait speed, sit-to-stand time, 3-m walking time, turning time and step, and TUG. In addition, early step length and time were measured. AO consisted of 7.5 min of watching gait videos demonstrated by a healthy older person. Parameters were measured twice for the baseline to determine reproducibility using the intraclass correlation coefficient (ICC3,1). Data between before and after immediately applying AO were compared using the paired t-test. RESULTS: All outcomes showed moderate to excellent test-retest reliability (ICC3,1=0.51 0.99, p<0.05), except for the step time (ICC3,1=0.19, p=0.302), which showed poor reliability. There were significant improvements (p<0.05) in step time, early step time, gait speed, sit-to-stand time, and turning time after applying AO. Yet, the rest of the outcomes showed no significant change. CONCLUSIONS: A single session of AO is feasible to provide benefits for gait and mobility parameters. Therapists may modify this method in the training program to improve gait and mobility performances for iNPH patients.

A observação de ação (OA) teve benefícios comprovados em diversas condições neurológicas, mas nenhum estudo foi conduzido anteriormente em Hidrocefalia de Pressão Normal idiopática (HPNi). OBJETIVO: O presente estudo teve como objetivo investigar a viabilidade da OA em pacientes com HPNi. MÉTODOS: Um projeto de pré-teste e pós-teste de grupo único foi realizado em 27 pacientes com HPNi. Parâmetros de marcha e mobilidade foram avaliados por meio de parâmetros 2D para a medida da marcha com o teste timed up and go (TUG) com duas tentativas antes e imediatamente depois do OA. Os resultados incluíram comprimento e tempo do passo, comprimento e tempo da passada, cadência, velocidade da marcha, tempo para sentar-e-levantar, tempo de caminhada de 3 metros, tempo de virada e passo, e tempo do teste (TUG). Além disso, o comprimento do passo inicial e o tempo da etapa inicial foram medidos. A OA consistia em assistir 7,5 minutos de vídeos de marcha demonstrados por um idoso saudável. Os parâmetros foram medidos duas vezes para a linha de base para determinar a reprodutibilidade usando o coeficiente de correlação intraclasse (CCI3,1). Os dados entre antes e depois da aplicação imediata de OA foram comparados com o teste t pareado. RESULTADOS: Todos os resultados mostraram confiabilidade teste-reteste moderada a excelente (CCI3,1=0,51 0,99, p<0,05), exceto para o tempo do passo (CCI3,1=0,19, p=0,302), que apresentou confiabilidade pobre. Houve melhorias significativas (p<0,05) no tempo do passo, tempo do passo inicial, velocidade da marcha, tempo sentar-e-levantar e tempo de virar após a aplicação de OA. Os demais resultados não mostraram nenhuma mudança significativa. CONCLUSÕES: Uma única sessão de aplicação de OA é viável para proporcionar benefícios aos parâmetros de marcha e mobilidade. Os terapeutas podem modificar esse método no programa de treinamento para obter desempenho de marcha e mobilidade para pacientes com HPNi.

Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients / Viabilidade do efeito de observação da ação na marcha e mobilidade de pacientes com hidrocefalia de pressão normal idiopática

ABSTRACT. Action observation (AO) has been proved to be of benefit in several neurological conditions, but no study has previously been conducted in idiopathic normal pressure hydrocephalus (iNPH). Objective: This study aimed to investigate the feasibility of AO in iNPH patients. Methods: A single-group pretest-posttest design was conducted in twenty-seven iNPH patients. Gait and mobility parameters were assessed using the 2D gait measurement in the timed up and go (TUG) test for two trials before and after immediate AO training. The outcomes included step length and time, stride length and time, cadence, gait speed, sit-to-stand time, 3-m walking time, turning time and step, and TUG. In addition, early step length and time were measured. AO consisted of 7.5 min of watching gait videos demonstrated by a healthy older person. Parameters were measured twice for the baseline to determine reproducibility using the intraclass correlation coefficient (ICC3,1). Data between before and after immediately applying AO were compared using the paired t-test. Results: All outcomes showed moderate to excellent test-retest reliability (ICC3,1=0.51 0.99, p<0.05), except for the step time (ICC3,1=0.19, p=0.302), which showed poor reliability. There were significant improvements (p<0.05) in step time, early step time, gait speed, sit-to-stand time, and turning time after applying AO. Yet, the rest of the outcomes showed no significant change. Conclusions: A single session of AO is feasible to provide benefits for gait and mobility parameters. Therapists may modify this method in the training program to improve gait and mobility performances for iNPH patients.

RESUMO. A observação de ação (OA) teve benefícios comprovados em diversas condições neurológicas, mas nenhum estudo foi conduzido anteriormente em Hidrocefalia de Pressão Normal idiopática (HPNi). Objetivo: O presente estudo teve como objetivo investigar a viabilidade da OA em pacientes com HPNi. Métodos: Um projeto de pré-teste e pós-teste de grupo único foi realizado em 27 pacientes com HPNi. Parâmetros de marcha e mobilidade foram avaliados por meio de parâmetros 2D para a medida da marcha com o teste timed up and go (TUG) com duas tentativas antes e imediatamente depois do OA. Os resultados incluíram comprimento e tempo do passo, comprimento e tempo da passada, cadência, velocidade da marcha, tempo para sentar-e-levantar, tempo de caminhada de 3 metros, tempo de virada e passo, e tempo do teste (TUG). Além disso, o comprimento do passo inicial e o tempo da etapa inicial foram medidos. A OA consistia em assistir 7,5 minutos de vídeos de marcha demonstrados por um idoso saudável. Os parâmetros foram medidos duas vezes para a linha de base para determinar a reprodutibilidade usando o coeficiente de correlação intraclasse (CCI3,1). Os dados entre antes e depois da aplicação imediata de OA foram comparados com o teste t pareado. Resultados: Todos os resultados mostraram confiabilidade teste-reteste moderada a excelente (CCI3,1=0,51 0,99, p<0,05), exceto para o tempo do passo (CCI3,1=0,19, p=0,302), que apresentou confiabilidade pobre. Houve melhorias significativas (p<0,05) no tempo do passo, tempo do passo inicial, velocidade da marcha, tempo sentar-e-levantar e tempo de virar após a aplicação de OA. Os demais resultados não mostraram nenhuma mudança significativa. Conclusões: Uma única sessão de aplicação de OA é viável para proporcionar benefícios aos parâmetros de marcha e mobilidade. Os terapeutas podem modificar esse método no programa de treinamento para obter desempenho de marcha e mobilidade para pacientes com HPNi.

Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study.

BACKGROUND: Facet joint is a potential structure to be the source of chronic low back pain (LBP) affecting lumbar motion, pain, and disability. Other than the recommended treatment of lumbar stabilization exercise (LSE), several manual procedures including muscle energy technique (MET) are commonly used in physical therapy clinic. However, little evidences of the effects of MET have been reported. OBJECTIVE: This study aimed to compare the immediate effects of MET and LSE in patients with chronic LBP with suspected facet joint origin. METHODS: Twenty-one patients with low back pain were recruited and randomly assigned to receive treatment either MET or LSE. The outcomes were kinematic changes, pain intensity, and disability level. Lumbar active range of motion (ROM) of flexion, extension, left and right lateral flexion, and left and right rotation were evaluated using the three-dimension motion analysis system at baseline and immediately after treatment. Pain intensity was evaluated using visual analogue scale (VAS) at baseline, immediately after, and two days after treatment. Thai version of the modified Oswestry disability questionnaire (ODQ) was utilized at baseline and two days after treatment. The mixed model analysis of variance was used to analyze all outcomes. RESULTS: The results showed that all outcomes were not different between groups after treatments. Although there were statistically significant improvements after the treatments when collapsing the groups, the minimal clinically important change was found only for pain but not for lumbar movements and disabilities scores. CONCLUSION: The effect of MET and LSE alone in single session might not be intensive enough to improve movements and decrease disability in patients with chronic LBP with suspected facet joint origin.

Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis.

OBJECTIVES: This study aimed to investigate the effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis (PF). METHODS: A single group pre- and post-test design was conducted for this study in 20 patients with PF. They had the self home-based stretching program of calf muscle for 3 weeks. They were assessed for the multi-segmental foot motion (degree) and clinical outcomes which included the plantar fascia pain/disability scale (PFPS) (score), muscle length (degree) of gastrocnemius and soleus, and muscle strength (kg) of ankle dorsiflexors, plantarflexors, invertors, evertors, great toe flexors, and lesser toe flexors. RESULTS: There were no significant differences (p>0.05) in multi-segmental foot motion and muscle length after exercise. Significant improvements (p<0.05) were found in PFPS and muscle strength of ankle plantarflexors, invertors, evertors, great toe flexors, and lesser toe flexors after exercise. CONCLUSIONS: A home-based stretching exercise was an effective program for reducing pain, enhancing muscle strength for both extrinsic and intrinsic foot muscles in patients with PF.

Thai version of the foot function index: a cross-cultural adaptation with reliability and validity evaluation.

BACKGROUND: The study aimed to translate the foot function index (FFI) questionnaire to Thai and to determine psychometric properties of the questionnaire among individuals with plantar foot complaints. METHODS: The Thai version of the FFI (FFI-Th) was adapted according to a forward and backward translation protocol by two independent translators and analyzed by a linguist and a committee. The FFI-Th was administered among 49 individuals with plantar foot complaints to determine internal consistency, reliability, and validity. Cronbach's alpha and the Intraclass Correlation Coefficient (ICC3,1) were used to test the internal consistency and test-retest reliability. The Principal Component Analysis with varimax rotation method was used to test the factor structure and construct validity. Furthermore, the criterion validity was tested using Pearson's correlation coefficient (rp) between the FFI-Th and the visual analogue pain scale (pain-VAS) as well as the EuroQol five-dimensional questionnaire (EQ-5D-5L). RESULTS: The FFI-Th showed good to excellent internal consistency and test-retest reliability in the total score, pain, disability, and activity limitation subscales. The Principal Component Analysis produced 4 principal factors from the FFI-Th items. Criterion validity of the FFI-Th total score showed moderate to strong correlations with pain-VAS and EQ-5D-5L, and EQ-VAS scores. CONCLUSION: The FFI-Th was a reliable and valid questionnaire to assess the foot function in a Thai population. TRIAL REGISTRATION: NCT03161314 (08/05/2017).

Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial.

Owing to advancement of medical technology and current knowledge, the population has a longer life expectancy, leading to an increase in the proportion of elderly. OBJECTIVE: The study aimed to investigate the effect of action observation (AO) combined with gait training on gait and cognition in elderly with mild cognitive impairment (MCI). METHODS: Thirty-three participants were randomly allocated to action observation with gait training (AOGT), gait training (GT), and control (CT) groups. The AOGT and GT groups received a program of observation and gait training protocol with the same total duration of 65 min for 12 sessions. For the observation, the AGOT group watched a video of normal gait movement, while the GT group watched an abstract picture and the CT group received no training program. All participants were assessed for gait parameters during single- and dual-tasks using an electronic gait mat system and were assessed for cognitive level using the Montreal Cognitive Assessment (MoCA) at baseline, after training and at 1-month follow-up. RESULTS: The results showed that the AOGT group had significant improvements in gait speeds during single- and dual-tasks, as well as better MoCA score, while the GT group had significant improvement only in gait speed. CONCLUSION: The adjunct treatment of AO with gait training provides greater benefits for both gait and cognitive performances in elderly with MCI.

Com o avanço da tecnologia médica e do conhecimento atual, a população tem uma expectativa de vida mais longa, levando a um aumento na proporção de idosos. OBJETIVO: O estudo teve como objetivo investigar o efeito da observação de ação (AO) combinada com o treinamento da marcha na marcha e cognição em idosos com comprometimento cognitivo leve (CCL). MÉTODOS: Trinta e três participantes foram alocados aleatoriamente para observação de ação com grupos de treinamento de marcha (AOGT), treinamento de marcha (GT) e controle (CT). Os grupos AOGT e GT receberam um programa de observação e protocolo de treinamento de marcha com a mesma duração total de 65 minutos por 12 sessões. Na observação, o grupo AGOT assistiu a um vídeo de movimento normal da marcha, enquanto o grupo GT assistiu a uma figura abstrata e o grupo CT não recebeu nenhum programa de treinamento. Todos os participantes foram avaliados quanto aos parâmetros da marcha durante tarefas simples e duplas, utilizando um sistema eletrônico de esteira da marcha e avaliados quanto ao nível cognitivo, utilizando a Avaliação Cognitiva de Montreal (MoCA) na linha de base, após o treinamento e 1 mês de acompanhamento. RESULTADOS: Os resultados mostraram que o grupo AOGT apresentou melhorias significativas nas velocidades da marcha durante tarefas simples e duplas, além do escore MoCA, enquanto o grupo GT teve melhora significativa apenas na velocidade da marcha. CONCLUSÃO: O tratamento adjunto da AO com o treinamento da marcha proporciona maiores benefícios tanto do desempenho da marcha quanto do desempenho cognitivo em idosos com CCL.

Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial / Observação da ação e treinamento da marcha para melhorar a marcha e a cognição em idosos com comprometimento cognitivo leve: um estudo controlado randomizado

Abstract. Owing to advancement of medical technology and current knowledge, the population has a longer life expectancy, leading to an increase in the proportion of elderly. Objective: The study aimed to investigate the effect of action observation (AO) combined with gait training on gait and cognition in elderly with mild cognitive impairment (MCI). Methods: Thirty-three participants were randomly allocated to action observation with gait training (AOGT), gait training (GT), and control (CT) groups. The AOGT and GT groups received a program of observation and gait training protocol with the same total duration of 65 min for 12 sessions. For the observation, the AGOT group watched a video of normal gait movement, while the GT group watched an abstract picture and the CT group received no training program. All participants were assessed for gait parameters during single- and dual-tasks using an electronic gait mat system and were assessed for cognitive level using the Montreal Cognitive Assessment (MoCA) at baseline, after training and at 1-month follow-up. Results: The results showed that the AOGT group had significant improvements in gait speeds during single- and dual-tasks, as well as better MoCA score, while the GT group had significant improvement only in gait speed. Conclusion: The adjunct treatment of AO with gait training provides greater benefits for both gait and cognitive performances in elderly with MCI.

Resumo. Com o avanço da tecnologia médica e do conhecimento atual, a população tem uma expectativa de vida mais longa, levando a um aumento na proporção de idosos. Objetivo: O estudo teve como objetivo investigar o efeito da observação de ação (AO) combinada com o treinamento da marcha na marcha e cognição em idosos com comprometimento cognitivo leve (CCL). Métodos: Trinta e três participantes foram alocados aleatoriamente para observação de ação com grupos de treinamento de marcha (AOGT), treinamento de marcha (GT) e controle (CT). Os grupos AOGT e GT receberam um programa de observação e protocolo de treinamento de marcha com a mesma duração total de 65 minutos por 12 sessões. Na observação, o grupo AGOT assistiu a um vídeo de movimento normal da marcha, enquanto o grupo GT assistiu a uma figura abstrata e o grupo CT não recebeu nenhum programa de treinamento. Todos os participantes foram avaliados quanto aos parâmetros da marcha durante tarefas simples e duplas, utilizando um sistema eletrônico de esteira da marcha e avaliados quanto ao nível cognitivo, utilizando a Avaliação Cognitiva de Montreal (MoCA) na linha de base, após o treinamento e 1 mês de acompanhamento. Resultados: Os resultados mostraram que o grupo AOGT apresentou melhorias significativas nas velocidades da marcha durante tarefas simples e duplas, além do escore MoCA, enquanto o grupo GT teve melhora significativa apenas na velocidade da marcha. Conclusão: O tratamento adjunto da AO com o treinamento da marcha proporciona maiores benefícios tanto do desempenho da marcha quanto do desempenho cognitivo em idosos com CCL.

Clinimetric properties of the one-leg sit-to-stand test in examining unilateral lower limb muscle strength among young adults.

BACKGROUND: One-leg sit-to-stand (one-leg STS) test is a new clinical test developed to measure the unilateral lower limb (LE) muscle strength among young adults. This study examined the test-retest reliability and the criterion-concurrent validity of the one-leg STS. METHODS: Forty young adults (mean age ± SD, 28.07 ± 5.39 years) participated in the study. The one-leg STS test was administered in two separate assessment sessions to examine test-retest reliability. Two-leg STS test was administered and the performance time was measured. The concentric peak strength of hip flexors/extensors, knee flexors/extensors and ankle dorsi-flexors/plantar-flexors were determined using an isokinetic dynamometer. An intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of one-leg STS test. The criterion validity of the one-leg STS test was evaluated against the performance of the two-leg STS test using an independent sample t test. The concurrent validity of the one-leg STS test was evaluated by investigating the relationships between STS performance time and LE muscle strength using Pearson correlation coefficients. RESULTS:  The reliability analysis showed that one-leg STS performance time had excellent test-retest reliability (ICC3,1  = 0.960, P < .001). Also, the one-leg STS performance time was not different between the first and second sessions, t (39) = 0.672, P = .506. The performance time of the one-leg STS test was significantly greater than the two-leg STS test (t (39) = 20.63, P < .001). The performance time of the one-leg STS test significantly correlated with the concentric peak strength of all LE muscles (P < .05). CONCLUSIONS: The one-leg STS test demonstrated excellent reliability and criterion-concurrent validity against the two-leg STS and the LE muscle strength. The one-leg STS test was simple to administer and could be beneficial for the assessment of unilateral LE muscle strength of young adults in clinical settings.

A randomized controlled trial of motor imagery combined with structured progressive circuit class therapy on gait in stroke survivors.

Structured Progressive Circuit Class Therapy (SPCCT) was developed based on task-oriented therapy, providing benefits to patients' motivation and motor function. Training with Motor Imagery (MI) alone can improve gait performance in stroke survivors, but a greater effect may be observed when combined with SPCCT. Health education (HE) is a basic component of stroke rehabilitation and can reduce depression and emotional distress. Thus, this study aimed to investigate the effect of MI with SPCCT against HE with SPCCT on gait in stroke survivors. Two hundred and ninety stroke survivors from 3 hospitals in Yangon, Myanmar enrolled in the study. Of these, 40 stroke survivors who passed the selection criteria were randomized into an experimental (n = 20) or control (n = 20) group. The experimental group received MI training whereas the control group received HE for 25 minutes prior to having the same 65 minutes SPCCT program, with both groups receiving training 3 times a week over 4 weeks. Temporo-spatial gait variables and lower limb muscle strength of the affected side were assessed at baseline, 2 weeks, and 4 weeks after intervention. After 4 weeks of training, the experimental group showed greater improvement than the control group in all temporospatial gait variables, except for the unaffected step length and step time symmetry which showed no difference. In addition, greater improvements of the affected hip flexor and knee extensor muscle strength were found in the experimental group. In conclusion, a combination of MI with SPCCT provided a greater therapeutic effect on gait and lower limb muscle strengths in stroke survivors.

Concurrent validity and intratester reliability of the video-based system for measuring gait poststroke.

BACKGROUND AND PURPOSE: Spatio-temporal parameters are commonly used in gait assessment. Advanced tools provide valid and reliable data, considered very effective for physiotherapy intervention. However, these tools may be limited in clinical usage caused by complicated applicability, inaccessibility, and high cost. Therefore, a video-based system is an alternative choice that is easy and affordable for the clinical setting. The purpose of the study was to evaluate the concurrent validity of the video-based system against the validated instrumented gait system (Force Distribution Measurement [FDM]) on the spatio-temporal gait parameters in individuals with stroke. In addition, the intratester reliability of a novice tester was determined. METHODS: Twenty individuals with stroke participated in the study. Gait was captured by the video-based and FDM systems simultaneously to measure the degree of concurrent validity. Parameters composed of the affected and unaffected step lengths (cm) and step time (s), stride length (cm), gait velocity (m/s), and cadence (steps/min). Pearson correlation coefficient, paired t test, and intraclass correlation coefficient (ICC) were used to determine the concurrent validity, the difference of the data, and intratester reliability. RESULTS: All spatio-temporal gait parameters showed excellent degrees of correlation (rp = .94 to.99, p <.001) between the video-based and FDM systems. No significant difference in all parameters was found between the two systems. Excellent intratester reliability (ICC3,1 = 0.91 to 0.99, p < .001) of all gait parameters were found in a novice tester. CONCLUSION: The video-based system was valid and reliable for a novice tester to measure the spatio-temporal gait parameters in individuals with stroke.

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

PURPOSE: 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.

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

PURPOSE: 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.

Effects of Strengthening and Stretching Exercises on the Temporospatial Gait Parameters in Patients With Plantar Fasciitis: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of physical therapy interventions using strengthening and stretching exercise programs on pain and temporospatial gait parameters in patients with plantar fasciitis (PF). METHODS: Eighty-four patients with PF participated in the study and were randomly assigned to the strengthening or stretching exercise groups. All patients received 8 physical therapy interventions two times per week in the first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they continued the assigned exercise programs every day for 8 weeks. Pain visual analogue scale (VAS) scores at the worst and in the morning and temporospatial gait parameters were evaluated at the baseline, intermediate of the intervention, end of the intervention, and the first and second month follow-up. RESULTS: There were significant effects of the time on the worst pain, morning pain, cadence, stride time, stride length, total double support, and gait speed, but there was no effect on step width. In addition, the main effect of the group and the interaction effects of the time and the group were not found in any parameters. For intra-group comparisons, there were significant differences in worst pain, morning pain, cadence, and stride time among the assessment times in both groups. For inter-group comparisons, there were no significant differences in all parameters. CONCLUSION: Both strengthening and stretching exercise programs significantly reduced pain and improved gait in patients with PF.