The Relationship between Physical Activity Level and Functional Status of Subjects with High Spinal Cord Injury.

BACKGROUND: Spinal cord injuries are one of disability in Poland and in the world. METHODS: 80 subjects with a transverse injury of the cervical spinal cord were enrolled in the study. The study group included men aged 20-50, 33.1 ± 7.5. A total of 40 (50%) of the subjects comprised the physically active group (AG)-subjects doing wheelchair sport twice a week for 90 min a day. The physically inactive group (IG) comprised 40 (50%) subjects who had not participated in any sports activities. Statistical analyses were carried out using Shapiro-Wilk W-test and Mann-Whitney U test. RESULTS: Significant differences were found between the physically active and inactive men with regard to their functionality status. The biggest differences were found for turning over (p < 0.001) and in adopting a sitting position (p < 0.001). Persons in the AG group had better results in all assessed activities. The biggest differences were observed in the field of toilet and dressing up: tooth-brushing p < 0.007 and washing the top part of the body p < 0.002. CONCLUSIONS: People participating in regular physical activity-wheelchair rugby-after spinal cord injury have a better relationship with better fitness, greater independence and a better functional status.

Effects of Robotic Exoskeleton-Aided Gait Training in the Strength, Body Balance, and Walking Speed in Individuals With Multiple Sclerosis: A Single-Group Preliminary Study.

OBJECTIVE: To assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up. DESIGN: Single-group longitudinal preliminary study. SETTING: Individuals with multiple sclerosis (MS) at a hospital neurology ward. PARTICIPANTS: Participants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5. INTERVENTIONS: Exoskeleton-assisted walk training. MAIN OUTCOME MEASURES: Primary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3). RESULTS: At the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant. CONCLUSIONS: Individuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.

Analysis of the association between selected factors and outcomes of treadmill gait training with biofeedback in patients with chronic stroke.

OBJECTIVE: To examine the effects of age, time from stroke onset, gender and side of paresis in gait re-education with the use of treadmill with biofeedback, in patients with chronic stroke. METHODS: The study was performed with a group of 50 patients. 10-metre walk test, 2-minute walk test, "Up and Go" test, the number of steps performed with the paretic lower limb at a distance of 10 metres, Barthel index and FIM scale were used to assess the effects of rehabilitation. RESULTS: The study shows that the subjects' abilities and fitness prior to the rehabilitation were not related to age, sex or side of paresis. Analysis of the impact of age, time from stroke and sex on rehabilitation outcomes showed no statistically significant correlations. On the other hand, analysis of rehabilitation results relative to the side of paresis showed that the latter factor significantly differentiates rehabilitation outcomes measured with gait velocity test - p= 0.045. CONCLUSION: Age, duration of time from stroke onset, and sex do not affect outcomes of gait re-education based on treadmill training in patients at a chronic stage post-stroke and Brunnstrom recovery stage 3-4. Side of paresis significantly differentiates rehabilitation outcomes measured with speed test. The best scores in all the performance measures before rehabilitation were identified in the group 3-6 years after stroke.

The Efficacy of Gait Training Using a Body Weight Support Treadmill and Visual Biofeedback in Patients with Subacute Stroke: A Randomized Controlled Trial.

BACKGROUND: This study was designed to determine whether or not gait training based on the use of treadmill with visual biofeedback and body weight support (BWS) would produce better effects in patients with subacute stroke compared to BWS treadmill training with no visual biofeedback. MATERIALS AND METHODS: 30 patients with subacute stroke were randomly assigned to do body weight supported treadmill training with visual biofeedback (BB group) or BWS treadmill training without visual biofeedback. Their gait was assessed with a 3D system (spatiotemporal gait parameters and symmetry index) and by means of 2-minute walk test (2 MWT), 10-metre walk test (10 MWT), and Timed Up & Go test. Subjects in both groups participated in 15 treadmill training sessions (30 minutes each). RESULTS: The participants from both groups achieved a statistically significant improvement in spatiotemporal gait parameters, walking speed, endurance, and mobility. The average change in the BB group after the end of the programme did not differ significantly compared to the change in the control group. The change in the symmetry index value of stance phase in the BB group was 0.03 (0.02) and in the control group was 0.02 (0.02). The difference was not statistically significant (p = 0.902). The statistically significantly higher improvement in the BB group was found in the range of walking speed (p = 0.003) and endurance (p = 0.012), but the difference between groups was of low clinical significance. CONCLUSIONS: The findings do not confirm that BWS treadmill training with the function of visual biofeedback leads to significantly greater improvement in gait compared to BWS treadmill training with no visual biofeedback at an early stage after stroke. This study was registered at ClinicalTrials.gov, ID: ACTRN12616001283460.

An assessment of the relationship between the items of the observational Wisconsin Gait Scale and the 3-dimensional spatiotemporal and kinematic parameters in post-stroke gait.

BACKGROUND: There are few reports in the literature investigating the relationship between observational gait scales used to assess individuals after a stroke and objective data acquired from 3-dimensional gait analysis (3DGA). RESEARCH QUESTION: The objective of this study was to compare the relationship between the specific items of the Wisconsin Gait Scale (WGS) and the matching 3-dimensional (3D) spatiotemporal and kinematic gait parameters in individuals after a stroke. In this way we evaluated whether using the simple, inexpensive, easy-to-use, observational WGS can fully substitute for the very costly and time-consuming 3DGA. METHODS: The study group comprised 50 participants who had experienced a stroke and were in the chronic stage of recovery. The study participants' gait was evaluated by means of the WGS; spatiotemporal and kinematic gait parameters were examined in the Gait Laboratory with the use of the BTS Smart system. The 3D recording of gait was performed using 2 video cameras positioned in such a way that it was possible to obtain images in the frontal and the sagittal plane. RESULTS: The findings show strong (0.7 ≤ |R| < 0.9; p < 0.001) or very strong (0.9≤ |R| < 1; p < 0.001) correlation between the specific items of the WGS and the matching 3D gait parameters. SIGNIFICANCE: The WGS is a diagnostic tool useful for conducting observational gait analysis in people with post-stroke hemiparesis and in situations when the costly objective methods of gait assessment cannot be applied for various reasons, the scale may be an effective tool enabling the assessment of gait. The WGS may be particularly useful in the subacute period of stroke as video recording of walking takes considerably less time than 3DGA. The study has been registered at the ClinicalTrials.gov, ID: ACTRN12617000436370.

Relationships between walking velocity and distance and the symmetry of temporospatial parameters in chronic post-stroke subjects.

PURPOSE: Subjects with post-stroke hemiparesis frequently present with asymmetric gait patterns. Symmetry, reflecting similarities in temporospatial, kinematic parameters, is an important measure of gait assessment. The study was designed to examine the relationships between asymmetry of temporal, spatial and kinematic gait parameters and walking velocity and distance. METHODS: Temporospatial and kinematic gait parameters were examined in a group of 50 chronic post-stroke subjects and in a group of 25 healthy controls. Symmetry ratio was calculated for all the parameters. Gait velocity was measured during 10-metre test, the walking distance during 2-Minute Walk Test, and balance during Up and Go Test. RESULTS: The relationship between stance phase duration symmetry and gait speed was at a moderate level (r = -0.43, p = 0.0173). There was a moderate relationship between swing phase symmetry and walking velocity and distance. The findings did not show a significant correlation between step length symmetry versus gait speed and distance. CONCLUSIONS: There is a mild relationship between self-selected gait velocity and walking distance versus temporal parameters symmetry. The findings do not confirm a relationship between self-selected gait velocity and walking distance versus spatial and kinematic parameters as well as balance. Likewise, no evidence confirms that asymmetry of temporal, spatial, kinematic gait parameters changes with the age of post-stroke subjects or is related to the length of time from stroke onset. Given the above, gait symmetry may be recognized as an important indicator of the level of gait control in post-stroke patients because it enables unique gait assessment, independent from other parameters.

Analysis of consistency between temporospatial gait parameters and gait assessment with the use of Wisconsin Gait Scale in post-stroke patients.

INTRODUCTION: Due to the increasing incidence and social effects of stroke there is a growing interest in finding methods enabling gait analysis in this group of patients. Observational techniques are predominantly applied in clinical practice; on the other hand advanced quantitative methods allow in-depth multidimensional gait assessment. The present study was designed to assess the consistency between temporospatial gait parameters acquired through 3-dimensional gait analysis and the results of gait assessment with the use of observational WGS in post stroke hemiparetic patients. MATERIAL AND METHOD: The study was performed in a group of 30 post-stroke patients, over 6 months from the onset of ischaemic stroke, who were able to walk unassisted. Gait assessment based on WGS was performed by an experienced physiotherapist, with the use of video recordings. Assessment of temporospatial parameters was based on gait analysis performed with BTS Smart system. RESULTS: The findings show moderate correlation between WGS based gait assessment and gait velocity (r=-0.39; p=0.0316). Similar relationship was identified between gait cycle duration and score in WGS for both unaffected (r=-0.36; p=0.0477) and affected side (r=-0.37; p=0.0426). Higher correlation level was demonstrated for stance phase on the unaffected side and gait assessment based on WGS (r=0.58; p=0.0009). CONCLUSIONS: Gait assessments with the use of temporospatial parameters and with observational WGS were found to produce moderate and good consistent results. WSG is a useful, simple tool for assessing gait in post stroke hemiparetic patients.

Changes in Gait Symmetry After Training on a Treadmill with Biofeedback in Chronic Stroke Patients: A 6-Month Follow-Up From a Randomized Controlled Trial.

BACKGROUND One of the most significant challenges for patients who survive a stroke is relearning basic motor tasks such as walking. The goal of this study was to evaluate whether training on a treadmill with visual biofeedback improves gait symmetry, as well as spatiotemporal and kinematic gait parameters, in stroke patients. MATERIAL AND METHODS Thirty patients in the chronic phase after a stroke were randomly allocated into groups with a rehabilitation program of treadmill training with or without visual biofeedback. The training program lasted 10 days. Spatiotemporal and kinematic gait parameters were evaluated. For all parameters analyzed, a symmetrical index was calculated. Follow-up studies were performed 6 months after completion of the program. RESULTS The symmetrical index had significantly normalized in terms of the step length (p=0.006), stance phase time, and inter-limb ratio in the intervention group. After 6 months, the improvement in the symmetry of the step length had been maintained. In the control group, no statistically significant change was observed in any of the parameters tested. There was no significant difference between the intervention group and the control group on completion of the program or at 6 months following the completion of the program. CONCLUSIONS Training on a treadmill has a significant effect on the improvement of spatiotemporal parameters and symmetry of gait in patients with chronic stroke. In the group with the treadmill training using visual biofeedback, no significantly greater improvement was observed.

Evaluation of the impact of exercise of gait on a treadmill on balance of people who suffered from cerebral stroke.

PURPOSE: The aim of the study is to define the impact of exercise on a treadmill on static balance and stability of posture in a group of patients after cerebral stroke rehabilitated in a late period, with an application of a treadmill with the function of visual biofeedback. METHODS: The examination was carried out in a group of 46 people in a late period after ischemic cerebral stroke. The patients examined were randomly put to a group with intervention (n = 23), in which a rehabilitation programme with an application of a treadmill with the visual feedback function was realized and to a control group (n = 23). They evaluated balance in standing on both feet by means of a force plate, symmetry of load of lower limbs and dynamic balance in Up & Go test. RESULTS: A statistically significant change of stabilometric parameters was observed only in the area of postural sways of the centre of pressure (COP). A significant improvement of the symmetry of load of lower limbs in standing (p = 0.0266) was diagnosed in the examined group after the end of the programme. After the end of the programme no significant difference between the group with intervention and the control group as for a change of balance of the examined patients was found. CONCLUSIONS: In the examined group in the chronic period after cs no significant improvement of stabilometrically evaluated balance was obtained, but improvement of the symmetry of load of lower limbs as well as improvement of dynamic balance were observed.

Efficacy of gait training using a treadmill with and without visual biofeedback in patients after stroke: A randomized study.

OBJECTIVES: To evaluate the effects of gait training using a treadmill with and without visual biofeedback in patients in the late period after stroke, and to compare both training methods. DESIGN: A randomized, controlled study. SUBJECTS: Fifty people at least 6 months after stroke, randomly enrolled into groups with a rehabilitation programme of treadmill training with or without visual biofeedback. METHODS: Spatio-temporal gait parameters, walking speed, walking distance, self-reliant mobility and functional capacity were evaluated during a programme of 10 sessions over 2 weeks. RESULTS: Patients in both groups achieved statistically significant improvement. Participants in the intervention group revealed a significantly greater improvement in the shortening of the stance phase (p = 0.0045) and lengthening of the swing phase of the unaffected limb (p = 0.0042) and an increase in the unaffected limb cycle length (p = 0.0021). There were no significant differences between groups in other spatio-temporal parameters of gait or additionally assessed parameters. CONCLUSION: Gait training using a treadmill resulted in improvements in the gait and functional capacity of patients. The use of biofeedback gives better results in improving gait cycle length, duration of gait phases and swing phase speed compared with exercise on a treadmill alone.