'Draw your pelvis' test for assessing pelvic schema in people with Parkinson's disease: a validity and reliability study.

Aim: Body schema (i.e., the mental representation of the body and its parts) is important for cognitive and motor functions, with the pelvis constituting a core element in such schema. Although people with Parkinson's disease exhibit misperceptions and deficits in body schema, there are currently no published tools available for assessing pelvic schema in this population. This study aimed to develop and establish feasibility, reliability, and validity of a novel drawing test - 'Draw Your Pelvis' - for assessing pelvic schema in people with Parkinson's disease. Materials and methods: Twenty people with idiopathic Parkinson's disease (Hoehn &Yahr stages I-III; M age: 65.75 ± 10.13) volunteered and were asked to manually draw a picture of their pelvis. Drawings were assessed and scored by 13 blinded raters over two sessions. Intra- and inter-rater reliability and content and criterion validity were investigated. Results: The 'Draw Your Pelvis' test is shown to be feasible and quick to administer, with excellent inter-rater reliability for consistency (0.954-0.968) and absolute agreement (0.946-0.961). It also demonstrates good-excellent (0.614-0.950) intra-rater reliability, and is content valid. Conclusions: The 'Draw Your Pelvis' test holds potential for clinicians and researchers in assessing pelvic schema and its deficits in people with Parkinson's disease. In addition, this test could be used for investigating the effect of therapeutic interventions on body schema in this population. Future studies should explore this test in additional populations.

Psychometric properties of clock and pelvic drawings in Parkinson's disease: A validity and cross-sectional study.

OBJECTIVES: Parkinson's disease (PD) is characterized by visuospatial and body schema deficits. People with PD often exhibit hypometric movements and graphic hypometria (i.e., small drawing dimensions). The goal of the current study was to explore graphic-metric representation in people with PD by assessing pelvic and clock drawing dimensions (i.e., height and width) and by investigating associations between pelvic drawing dimensions and participant characteristics. METHODS: Twenty people (16 males, 4 females; M age: 65.75 ± 10.13 years) with idiopathic PD (Hoehn &Yahr Stages I-III) volunteered to participate in this study. Draw Your Pelvis and Clock Drawing tests were used for assessing drawing dimensions, which were then correlated with PD severity, stage and duration, cognitive level, side of symptoms onset, and pelvic schema score. Bivariate and multiple linear regression analyses were also used. RESULTS: Excellent (.844-.999) interrater reliability was shown for measuring pelvic and clock drawing dimensions. Pelvic drawing dimensions did not significantly (P > .05) differ in magnitude, whereas clock drawing height was significantly (p < .01) greater than width, both suggesting graphic dysmetria (i.e., distorted graphic dimensions). Pelvic drawing width was negatively associated with PD severity and stage, was positively associated with pelvic schema score, and predicted all three parameters. CONCLUSION: Measuring pelvic drawing dimensions, and specifically pelvic drawing width, holds potential as an adjunct diagnostic measure in PD assessments and for detecting pelvic schema deficits or misperceptions. This test can be used by physical therapists in the clinic for assessing disease severity, stage, and pelvic schema in people with PD. The knowledge gained from this study contributes to a greater understanding of graphic-metric representation and associated deficits in people with PD. Future studies should explore the relationship between pelvic drawing dimensions and pelvic mentally imaged estimates, and their role in motor planning, control, and execution in people with PD.

"Will you draw me a pelvis?Ë® Dynamic neuro-cognitive imagery improves pelvic schema and graphic-metric representation in people with Parkinson's Disease: A randomized controlled trial.

BACKGROUND: Body schema (i.e., the mental representations of the body), vital for motor and cognitive functions, is often distorted in people with Parkinson's disease (PD). Deficits in body, and especially pelvic, schema can further exacerbate motor and cognitive deficits associated with PD. Such deficits, including those in graphic and metric misjudgments, can manifest in drawing tasks. Mental imagery is a recommended approach for PD rehabilitation with potential for ameliorating body schema. OBJECTIVE: To investigate the effect of a two-week dynamic neuro-cognitive imagery (DNI) training versus in-home learning and exercise control (learning/exercise) on pelvic schema and graphic representation (i.e., drawing height and width). DESIGN: Twenty participants with idiopathic PD (Hoehn&Yahr I-III; M age: 65.75 ±â€¯10.13) were randomly allocated into either a DNI or a learning/exercise group. Participants were asked to complete the "Draw Your PelvisË® test in which they drew their pelvis at pre- and post-intervention. Drawings were assessed for pelvic schema score and drawing dimensions (i.e., height and weight). INTERVENTION: DNI anatomical and metaphorical imagery focusing on pelvic anatomy and biomechanics. RESULTS: No difference (p > .05) was detected at baseline between drawn pelvis height and width. Following intervention, improvements were greater in the DNI group for pelvic schema (p < .01), drawn pelvic width (p < .05) and width-height difference (p < .05). CONCLUSIONS: This study suggests that DNI could serve as a rehabilitation path for improving body schema in people with PD. Future studies should explore DNI mechanisms of effect and the effect of enhanced pelvic schema on motor and non-motor deficits in this population.

Kinematic and Kinetic Analysis of Repeated and Static Elevé in Adolescent Female Dance Students.

Elevé is a fundamental dance movement practiced routinely by dance students and serving as an integral component of screening in dance. It consists of ankle plantar flexion (PF) movement and is considered to be a frequent cause of foot and ankle injuries among dancers, with adolescent female dance students being at greatest risk for such injuries. Therefore, gaining additional knowledge regarding elevé functional range of motion (ROM) and inter-leg weightbearing distribution (WBD) properties among adolescent dance students is warranted for pedagogic, screening, injury prevention, and rehabilitation purposes. The aims of this study were three-fold: 1. to report and compare dance-specific, functional kinematic (ankle PF maximum angle and ankle PF ROM), kinetic (inter-leg WBD), and self-reported level of difficulty (balance, muscular force, and concentration) properties of repeated and static elevé among adolescent female dance students; 2. to look for correlations between elevé properties and participants' demographics (age, height, weight, dance experience, and leg dominance); and 3. to describe the relationships between the two kinematic properties in both elevé tasks. Twenty-three adolescent female dance students (mean age 13.57 ± 0.50 years) were measured while performing two elevé tasks: 10 repetitions ("repeated elevé task") and 10 consecutive seconds hold ("static elevé task"). Data regarding ankle motion and WBD were collected and analyzed using three-dimensional motion capture and two force plates. The data gained from this study expand our current understanding of elevé dance movement and may contribute to clinical relevancy and applicability of screening procedures being conducted in pre-professional dance settings. This may help to identify adolescent dance students with the potential to undertake a career in professional dance as well as to investigate the parameters associated with risk of ankle injuries in this population.

External validity of post-stroke interventional gait rehabilitation studies.

Gait rehabilitation is a major component of stroke rehabilitation, and is supported by extensive research. The objective of this review was to examine the external validity of intervention studies aimed at improving gait in individuals post-stroke. To that end, two aspects of these studies were assessed: subjects' exclusion criteria and the ecological validity of the intervention, as manifested by the intervention's technological complexity and delivery setting. Additionally, we examined whether the target population as inferred from the titles/abstracts is broader than the population actually represented by the reported samples. METHODS: We systematically researched PubMed for intervention studies to improve gait post-stroke, working backwards from the beginning of 2014. Exclusion criteria, the technological complexity of the intervention (defined as either elaborate or simple), setting, and description of the target population in the titles/abstracts were recorded. RESULTS: Fifty-two studies were reviewed. The samples were exclusive, with recurrent stroke, co-morbidities, cognitive status, walking level, and residency being major reasons for exclusion. In one half of the studies, the intervention was elaborate. Descriptions of participants in the title/abstract in almost one half of the studies included only the diagnosis (stroke or comparable terms) and its stage (acute, subacute, and chronic). CONCLUSIONS: The external validity of a substantial number of intervention studies about rehabilitation of gait post-stroke appears to be limited by exclusivity of the samples as well as by deficiencies in ecological validity of the interventions. These limitations are not accurately reflected in the titles or abstracts of the studies.

Motor Imagery Practice for Enhancing Elevé Performance Among Professional Dancers: A Pilot Study.

OBJECTIVE: Elevé is a core dance movement requiring the greatest ankle plantarflexion (PF) range of motion (ROM). One possible way to enhance elevé performance is by using motor imagery practice (MIP). The aims of this pilot study were to investigate: 1) functional ankle PF maximal angles and ROM while performing elevé among professional dancers, 2) the effect of MIP on enhancing elevé performance, and 3) participants' views on the MIP intervention and its feasibility in a professional dance company setting. METHODS: Five professional dancers, mean age 31 yrs (SD 1.87), participated in a 2-week MIP intervention. Data on ankle PF maximal angles and ROM were collected pre- and post-intervention using 3-dimensional motion capture while performing repeat (10 repetitions) and static (10 sec) elevé. RESULTS: At baseline, ankle PF maximal angles were 169.20° (SD 2.81°) and 168.36° (2.23°) and ankle PF ROM were 40.21° (3.35°) and 35.94° (3.95°) for the repeat and static tasks, respectively. After the MIP intervention, ankle PF maximal angles were 170.28° (4.26°) and 170.74° (3.77°) and ankle PF ROM were 41.53° (2.33°) and 39.30° (2.30°) for the repeat and static tasks, respectively. Feasibility of MIP was established with 100% compliance and positive views were expressed by participants. CONCLUSION: The results suggest MIP holds potential as an adjunct training method for enhancing elevé performance among professional dancers.

Dynamic push-pull characteristics at three hand-reach envelopes: applications for the workplace.

Pushing and pulling are common tasks in the workplace. Overexertion injuries related to manual pushing and pulling are often observed, and therefore the understanding of work capacity is important for efficient and safe workstation design. The purpose of the present study was to describe workloads obtained during different reach envelopes during a seated push-pull task. Forty-five women performed an isokinetic push-pull sequence at two velocities. Strength, work and agonist/antagonist muscle ratio were calculated for the full range of motion (ROM). We then divided the ROM into three reach envelopes - neutral, medium, and maximum reach. The work capacity for each direction was determined and the reach envelope work data were compared. Push capability was best at medium reach envelope and pulling was best at maximum reach envelope. Push/pull strength ratio was approximately 1. A recommendation was made to avoid strenuous push-pull tasks at neutral reach envelopes.

Electrophysiological manifestations of mirror visual feedback during manual movement.

OBJECTIVE: To investigate the neurophysiological manifestations of the mechanism underlying the effects of Mirror Visual Feedback (MVF) during manual movement. METHOD: Thirteen healthy right handed individuals were assessed while performing repeated unilateral wrist extension movements with and without MVF. The effect of MVF on EEG oscillations was studied in 3 distinct frequency ranges (low mu, high mu, low beta). RESULTS: Analysis of the low beta range showed that MVF reduces the magnitude of event-related de-synchronization (ERD) in the hemisphere contra-lateral to the moving hand. This effect reached significance when the moving hand was the dominant hand. In the analysis of the low mu range, bi-hemispheric amplification of ERD by the mirror pointed to an added effect of neural recruitment. This effect reached significance when the moving hand was the non-dominant hand. CONCLUSIONS: MVF applied during unilateral manual movement (a) attenuates hemispheric activation asymmetry, and (b) is likely to involve recruitment of the mirror neuron system. SIGNIFICANCE: As each of the above two effects reached significance only in one hand (dominant and non-dominant, respectively), clinical application of MVF might show a different level of efficacy in the treatment of right and left hemiparesis.

Anxiety among individuals with visual vertigo and vestibulopathy.

PURPOSE: Visual vertigo (VV) is a type of dizziness triggered by visual stimuli. Despite a high incidence, its relationship with anxiety is not well-defined or understood. This study evaluated anxiety levels in subjects with VV compared to vestibulopathic subjects without VV and healthy individuals. METHODS: A cross-sectional study to evaluate anxiety among individuals with VV was conducted twice. The first study included 72 participants (66 to 83 years of age) from senior residential centers. The second included 31 participants from a vestibular rehabilitation program (age range 35-82 years). Study 1 also used the Activities-Specific Balance Confidence (ABC) scale and study 2 the Dizziness Handicap Inventory (DHI). RESULTS: Subjects were classified as VV positive (27 in study 1, 10 in study 2) or vestibulopathic without VV (30 in study 1, 11 in study 2) based on Head Impulse or Dynamic Visual Acuity Tests and the Dizziness Questionnaire. The remaining were age-matched healthy controls. The outcome of each study demonstrated significantly higher anxiety levels (p = 0.0001) in the VV group compared to the other groups. The results of the ABC test demonstrated that subjects in the VV group had significantly lower self-confidence (p = 0.001) than those in the Vest and Cont groups and performed fewer balance-related activities of daily life. DHI results showed that VV group expressed higher (p < 0.001) mean scores for self-perceived feelings of dizziness and imbalance (54%), compared to the Vest (9%) and Cont groups (1%). CONCLUSIONS: Anxiety related to VV requires special attention when assessing and managing vestibulopathy, regardless of patient age. IMPLICATIONS FOR REHABILITATION: Anxiety is a characteristic of subjects with visual vertigo (VV) and vestibulopathy. Anxiety in subjects with VV is not related to age. VV should be considered when subjects with anxiety complain of imbalance. Anxiety and vestibulopathy are often interrelated and should be considered in diagnostic evaluations.

EMG activity of finger flexor muscles and grip force following low-dose transcutaneous electrical nerve stimulation in healthy adult subjects.

Somatosensory stimulation modulates cortical and corticospinal excitability and consequently affects motor output. Therefore, low-amplitude transcutaneous electrical nerve stimulation (TENS) has the potential to elicit favorable motor responses. The purpose of the two presented pilot studies was to shed light on TENS parameters that are relevant for the enhancement of two desirable motor outcomes, namely, electromyographic (EMG) activity and contraction strength of the finger flexors and wrist muscles. In 5 and 10 healthy young adults (in Study I and Study II, respectively) TENS was delivered to the volar aspect of the forearm. We manipulated TENS frequency (150 Hz vs. 5 Hz), length of application (10, 20, and 60 min), and side of application (unilateral, right forearm vs. bilateral forearms). EMG amplitude and grip force were measured before (Pre), immediately after (Post), and following 15 min of no stimulation (Study I only). The results indicated that low-frequency bursts of TENS applied to the skin overlying the finger flexor muscles enhance the EMG activity of the finger flexors and grip force. The increase in EMG activity of the flexor muscles was observed after 20 min of stimulation, while grip force was increased only after 1 h. The effects of uni- and bilateral TENS were comparable. These observations allude to a modulatory effect of TENS on the tested motor responses; however, unequivocal conclusions of the findings are hampered by individual differences that affect motor outcomes, such as in level of attention.

The influence of visual vertigo and vestibulopathy on oculomotor responses.

OBJECTIVE: Dynamic visual inputs can cause visual vertigo (VV) in patients with vestibulopathy, leading to dizziness and falls. This study investigated the influence of VV on oculomotor responses. METHODS: In this cross-sectional, single-blind study, with experimental and control groups, 8 individuals with vestibulopathy and VV, 10 with vestibulopathy and no VV, and 10 healthy controls participated. Oculomotor responses were examined with 2-dimensional video-oculography. Participants were exposed to dynamic visual inputs of vertical stripes sweeping across a screen at 20 deg/sec, while seated or in Romberg stance, with and without a fixed target. Responses were quantified by optokinetic nystagmus frequency (OKNf) and gain (OKNg). RESULTS: Seated with no target, VV participants had higher OKNf than controls (37 ± 9 vs. 24 ± 9 peaks/sec; P < 0.05). In Romberg stance with no target, they had higher OKNf than controls (41 ± 9 vs. 28 ± 10 peaks/sec; P < 0.05). With a target, OKNf was higher in VV participants compared to controls (7 ± 7 vs. 1 µ 2 peaks/sec; P < 0.05). In Romberg with no target, OKNg was higher in the VV group (0.8 ± 0.1) compared to controls (0.6 ± 0.2; P=0.024). OKNf and OKNg did not differ according to VV status. CONCLUSIONS: VV participants had increased OKNf and OKNg compared to healthy participants. Visual dependency should be considered in vestibular rehabilitation.

Motor imagery group practice for gait rehabilitation in individuals with post-stroke hemiparesis: a pilot study.

BACKGROUND: Stroke is the leading cause of adult disability, with walking impairment being a devastating indicator of chronic post-stroke hemiparesis. Limited resources exist for individual treatments; therefore, the delivery of safe group exercise therapy is highly desired. OBJECTIVE: To examine whether the application of group-based motor imagery practice to community-dwelling individuals with chronic hemiparesis improves gait. METHODS: Sixteen individuals with chronic hemiparesis from two community centers participated in the study, with eight from each center. Four participants in each center received five weeks of the experimental intervention, consisting of group-based motor imagery exercises of gait tasks, followed by five weeks of control treatment of motor imagery exercises for the affected upper extremity. Four other subjects in each center received the same treatments in reverse order. Pre- and post intervention measurements included clinical and biomechanical gait parameters. RESULTS: Comparisons within (pre- vs. post) and between treatments (experimental vs. control) indicated no significant change in any gait variable. Nevertheless, the verbal reports of most participants alluded to satisfaction with the experimental intervention and to an increase in self-confidence. CONCLUSIONS: Despite the lack of evidence for the effectiveness of group-based motor imagery practice in improving gait among individuals with chronic hemiparesis, the contrast between the measured outcomes and the positive verbal reports merits further inquiry.

Effects of integrated motor imagery practice on gait of individuals with chronic stroke: a half-crossover randomized study.

OBJECTIVES: To test the effects of a new motor imagery practice approach, in which motor and motivational contents were integrated in order to improve gait in subjects with chronic poststroke hemiparesis. DESIGN: A half-crossover study composed of 2 phases. In phase 1, subjects were randomly assigned to receive either the experimental or the control treatment. In phase 2, the subjects who had initially received the control treatment "crossed over" to receive the experimental intervention. SETTING: The experimental and the control intervention were delivered in the subjects' homes; assessments were performed in a hospital laboratory. PARTICIPANTS: Community-dwelling individuals (N=23) with chronic poststroke hemiparesis whose gait was impaired. INTERVENTIONS: The experimental intervention, called integrated motor imagery practice, consisted of imagery scripts aimed at improving home and community walking as well as fall-related self-efficacy. The control treatment consisted of executed exercises to improve the function of the involved upper extremity. MAIN OUTCOME MEASURES: In-home walking, indoor and outdoor community ambulation, and fall-related self-efficacy. These were assessed before and after the intervention as well as at a 2-week follow-up. RESULTS: In-home walking was significantly improved after application of the experimental intervention (P≤.003), but not after the control treatment (P≤.68). Community ambulation did not improve. Fall-related self-efficacy was slightly improved by the integrated motor imagery intervention; however, the findings were not unequivocal. CONCLUSIONS: Home delivery of integrated motor imagery practice was feasible and exerted a positive effect on walking in the home. However, it was ineffective for improving gait in public domains. We speculate that the addition of physical practice to imagery practice may be essential for achieving that end.

Motor imagery practice for improving sit to stand and reaching to grasp in individuals with poststroke hemiparesis.

BACKGROUND: Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. PURPOSE: To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. METHOD: The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. Measurements of real performance took place twice before and twice immediately following each practice session. For STS, the Tetrax Balance System was used to measure the speed of performance and weight distribution between the legs. Reaching to grasp was appraised via a "kinematic" glove and included speed variables of the hand. RESULTS: A significant decrease was found in the values of STS duration. Weight distribution between the legs was not affected by the intervention. For reaching to grasp, a significant improvement was found in the mean and the maximum reaching velocity. CONCLUSIONS: In individuals with chronic hemiparesis, the imagery practice of meaningful motor tasks can positively affect real performance.

Metronome rate and walking foot contact time in young adults.

It is assumed that when people walk guided by an audible constant rate, they match foot contact to the external pace. The purpose of this preliminary study was to test that assumption by examining the temporal relationship between audible signals generated by a metronome and foot contact time during gait. Ten healthy young women were tested in walking repetitions guided by metronome rates of 60, 110, and 150 beats/min. Metronome beats and foot contact times were collected in real time. The findings indicated that foot contact was not fully synchronized with the auditory signals; the shortest time interval between the metronome beat and foot contact time was at the prescribed rate of 60 beats/min., while the longest interval was at the rate of 150 beats/min. The correlation between left and right foot contact times was highest with the slowest rate and lowest with the fastest rate.

Patient-centered integrated motor imagery delivered in the home with telerehabilitation to improve walking after stroke.

BACKGROUND AND PURPOSE: This case report describes the clinical reasoning process used to examine a person after stroke and intervene with a novel integrated motor imagery treatment designed for the rehabilitation of walking and delivered in the home through telerehabilitation. The integrated motor imagery treatment consisted of patient-centered goal setting and physical practice combined with motor and motivational imagery. CASE DESCRIPTION: The patient was a 38-year-old woman who had had a diffuse left subarachnoid hemorrhagic stroke 10 years earlier. She lived independently in an assisted living complex and carried a straight cane during long walks or in unfamiliar environments. Examination revealed a slow gait speed, reduced walking endurance, and decreased balance confidence. Although she was in the chronic phase, patient-centered integrated motor imagery was predicted to improve her community mobility. Treatment sessions of 45 to 60 minutes were held 3 times per week for 4 weeks. The practiced tasks included transitioning from sitting to standing, obstacle clearance, and navigation in interior and exterior environments; these tasks were first executed and then imagined at ratios of 1:5. Task execution allowed the creation of a scene based on movement observation. Imagery scenarios were customized to address the patient's goals and observed movement problems. Motivational elements of arousal, problem solving, and reward were embedded in the imagery scenarios. Half of the sessions were provided on site, and the remaining sessions were delivered remotely. Seven sessions were delivered by the clinician in the home, and 5 sessions were delivered using telerehabilitation. OUTCOMES: Improvements in motor imagery ability, gait parameters, and balance were observed after training. Most gains were retained at the 3-month follow-up. Compared with on-site delivery, the telerehabilitation sessions resulted in less therapist travel time and cost, as well as shorter therapy sessions. DISCUSSION: The delivery of integrated motor imagery practice for walking recovery was feasible both on site and remotely.

Effects of explicit prioritization on dual task walking in patients with Parkinson's disease.

Patients with Parkinson's disease (PD) have difficulties performing a dual task (DT) while walking and may use the "posture second" strategy. It is not clear if this is a result of motor or cognitive impairments. We examined the effects of explicit prioritization of walking or the cognitive task on gait speed (GS) and variability in 20 patients (Hoehn & Yahr stage: 2.3 ± 0.5) and 20 healthy older adults during usual-walking and under three DT (verbal-fluency) conditions: (1) no instruction for prioritization, (2) specific attention to the walking pattern (gait prioritization), and (3) specific attention to the cognitive task (prioritization of verbal-fluency). The Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Trail Making Tests assessed cognitive status. The two groups did not differ on these cognitive tests. Compared to usual-walking, all subjects reduced their GS in the un-instructed DT condition. Compared to the un-instructed DT condition, both groups significantly (p < 0.001) increased GS when prioritizing walking and maintained about the same GS when prioritizing the cognitive task (p > 0.155). All three DT conditions increased gait variability in both groups (p < 0.001 usual-walking compared to uninstructed DT). Verbal-fluency tended (p = 0.073) to be influenced by prioritization in both groups. Task prioritization abilities were similar in the patients and controls, even though the patients generally walked more slowly. PD patients without cognitive impairment apparently utilize their cognitive resources in the same manner as healthy older adults. Both groups, however, use some form of the posture second strategy and naturally focus on the cognitive task.

Walking speed, unilateral leg loading, and step symmetry in young adults.

The purpose of this study was to examine the effects of gait speed and unilateral lower limb loading on step time and step length symmetry in healthy adults. Spatiotemporal gait data were collected from 22 healthy subjects (11 men, 11 women), using the GaitRite walkway, under four randomly sequenced test conditions: self-selected speed (SS), fast speed (F), self-selected speed with the right leg loaded (LSS), and the fastest attainable speed with the right leg loaded (LF). The symmetry index, calculated with the formula [((R-L)/0.5 × (R+L)) × 100], was used to quantify step time and step length symmetry. It was found that over-ground gait speed had no significant effects on the symmetry of step time or step length. Unilateral lower limb loading significantly increased step time asymmetry, with longer step time for the loaded leg. Step symmetry was further compromised and became more asymmetrical when, in addition to unilateral leg loading, subjects maximized their gait speed. This effect of fast speed with unilateral leg loading was particularly prominent in relation to step length, with its shortening in the unloaded leg and lengthening in the loaded leg. These observations in healthy subjects may serve as a reference for the assessment of gait symmetry in patients with unilateral lower limb pathologies.

Intensive intermittent physical therapy in infants with cerebral palsy: a randomized controlled pilot study.

BACKGROUND: The effectiveness of intensive versus standard physical therapy for motor progress in children with cerebral palsy is controversial. Sitting acquisition is considered an important developmental milestone. OBJECTIVES: To assess the acquisition of sitting and gross motor progress in infants with cerebral palsy treated with intermittent intensive physical therapy as compared to a matched group treated with a standard physical therapy regimen. METHODS: We conducted a randomized controlled crossover study in 10 infants aged 12-22 months with cerebral palsy; 5 were assigned to the intensive intermittent therapy group and 5 to the control group. After 4 weeks of baseline intervention, the intervention program was administered to the experimental group for8 weeks and the regularly scheduled weekly program to the comparison group, targeting sitting as the treatment goal. Thereafter the comparison group crossed over. The Gross Motor Function Measure 66 and 88 (GMFM 66 and 88) were used at 4 week intervals. RESULTS: The intermittent intensive regimen yielded a mean improvement of 7.8% as compared to 1.2% with the standard treatment. However, these results were attributed to infants with a low functional level only (P < 0.01). CONCLUSIONS: Goal-directed intensive intermittent regimen could possibly be beneficial in infants with a low functional level.

Construct validation of a knee-specific functional status measure: a comparative study between the United States and Israel.

BACKGROUND: Comparative effectiveness research (CER) requires valid outcome measures that discriminate patients by risk factors in similar ways across settings. Standardized functional status (FS) measures in physical therapy are used routinely in multiple countries, creating the potential for CER among countries. OBJECTIVE: The purpose of this study was to assess known-groups construct validity of a knee-specific FS measure within and between 2 countries for patients receiving outpatient physical therapy due to knee impairments. DESIGN: This was a longitudinal, observational cohort study. METHODS: The participants were 4,972 and 2,964 adult (age ≥18 years) patients with knee impairments from Israel and the United States, respectively. Differences in patient characteristics between the 2 countries were assessed using chi-square statistics and 2-sample t tests, as appropriate. Known-groups validity within and between the countries was assessed using 2-way analysis of covariance predicting FS at discharge, with sex, age, symptom acuity, surgical and exercise history, intake medication use, and country as risk-adjustment factors. Intake FS was the covariate. To compare how FS discriminated patient groups between countries, each factor was tested separately with models including an interaction term between the factor and country. RESULTS: Patients were different between countries but had similar discharge FS trends, including: higher outcomes in patients who were male, were younger, had acute conditions, had one surgical procedure related to their knee impairment, were more physically active, and did not use related medication at admission. Interactions were not significant for sex, symptom acuity, and exercise history but were significant for age, surgical history, and medication use. Limitations Although strict patient selection criteria were set, some patient selection bias still might have existed. CONCLUSIONS: The results demonstrated the knee FS measures would be valid for use in CER between Hebrew-speaking patients (Israel) and English-speaking patients (United States).