Acute effects of locomotor training on overground walking speed and H-reflex modulation in individuals with incomplete spinal cord injury.

OBJECTIVE: The purpose of this study was to assess the effect of a single bout of a locomotor-training paradigm on overground walking speed and H-reflex modulation of individuals with incomplete spinal cord injury (SCI). METHODS: Self-selected and maximum walking speeds and soleus H-reflexes (H/M ratios) during standing and stance and swing phases of walking (self-selected velocity) were obtained from 4 individuals with American Spinal Injury Association impairment classification D. Data were collected immediately before and after a single bout of locomotor training with body weight support on a treadmill. The pretraining H/M ratios of the SCI subjects were also compared with values from 4 able-bodied subjects who did not receive the intervention. Maximum H/M ratios while standing and during midstance and midswing phases of overground walking were considerably greater in the SCI subjects than in the control subjects. RESULTS: After the single bout of training, self-selected and maximum overground walking speeds of the subjects with SCI increased by 26% and 25%, respectively. Furthermore, H-reflexes were significantly more depressed in the SCI subjects during overground walking (28% less during stance, 34% less during swing). CONCLUSIONS: Although preliminary, these findings indicate that a single bout of locomotor training produced immediate increases in walking velocity and acute neurophysiologic changes in individuals with incomplete SCI.

Concurrent and construct validity of scores on the Timed Movement Battery.

BACKGROUND AND PURPOSE: The Timed Movement Battery (TMB) is a new assessment tool designed to measure mobility in elderly individuals. "Mobility" was defined as a person's ability to maneuver his or her body independently in order to accomplish everyday tasks. The purpose of this study was to assess the concurrent and construct validity of scores obtained with the TMB as a measure of mobility in a group of elderly individuals who reported moderate or no difficulty in performing either basic or instrumental activities of daily living (BADL or IADL). SUBJECTS: Thirty community-dwelling elderly people, with a mean age of 77.5 years (SD=7.0, range=65-92), participated in this study. METHODS: Subjects responded to 2 questionnaires regarding their activities of daily living (ADL) (ie, Barthel Index and an 18-item ADL/IADL scale) and completed 3 assessments of mobility (ie, Berg Balance Scale, Timed "Up & Go" Test, and the TMB). Subjects were asked to perform the items on the TMB at a "self-selected" speed (their normal speed) and at a "maximum-movement" speed (as quickly as they could safely perform the items). Subjects' scores on the TMB were cross-correlated with data for 4 criterion tests (ie, Berg Balance Scale, Timed "Up & Go" Test, Barthel Index, and the 18-item ADL/IADL scale) using Spearman rank correlations and Pearson product moment correlations. RESULTS: Composite scores of the TMB performed at self-selected speeds correlated highly with data for the criterion tests and differentiated between those subjects reporting difficulty with ADL and those reporting no difficulty. CONCLUSION AND DISCUSSION: These results support the validity of scores obtained with the TMB as a measure of mobility in this sample of elderly individuals with moderate or no reported difficulty with ADL.

Turning difficulty characteristics of adults aged 65 years or older.

BACKGROUND AND PURPOSE: Falls that occur while walking have been associated with an increased risk of hip fracture in elderly people. This study's purpose was to describe movement characteristics in older adults that serve as indicators of difficulty in turning while walking. SUBJECTS: Three groups were assessed: young adults who had no difficulty in turning (age range=20-30 years, n=20) (YNDT group), elderly adults who had no difficulty in turning (age range=65-87 years, n=15) (ENDT group), and elderly adults who had difficulty in turning (age range=69-92 years, n=15) (EDT group). METHODS: All subjects were videotaped performing a self-paced 180-degree turn during the Timed "Up & Go" Test. Movement characteristics of each group were identified. Four characteristics were used to identify difficulty in turning: (1) the type of turn, (2) the number of steps taken during the turn, (3) the time taken to accomplish the turn, (4) and staggering during the turn. RESULTS: In general, the EDT group took more steps during the turn and more time to accomplish the turn than the YNDT and ENDT groups. Although the only turning strategy used by the YNDT group was a pivot type of turn, there was an almost total absence of a pivot type of turn in the EDT group. No differences were found among the groups on the staggering item, yet the EDT group was the only group in which staggering was present. We believe these changes observed in the 4 characteristics only in the EDT group are indicators of difficulty in turning while walking. CONCLUSION AND DISCUSSION: These indicators of difficulty may be useful for the early identification of individuals aged 65 years or older who are having difficulty in turning and may well serve as the basis for the development of a scale for difficulty in turning in older adults. Preliminary findings indicate the need for further study into the reliability, validity, and sensitivity of measurements obtained with such a scale.