New assistive walker improved local dynamic stability in young healthy adults.

In this study, we investigated the effect of walker type on gait pattern characteristics comparing normal gait (NG), gait with a regular walker (RW), and gait with a newly developed walker with vertical moveable handlebars, the Crosswalker (CW). Partial weight bearing (PWB) of the feet, peak joint angles and largest Lyapunov exponent (λmax) of the lower extremities (hip, knee, ankle) in the sagittal plane, and gait parameters (gait velocity, stride length, cadence, stride duration) were determined for 18 healthy young adults performing 10 walking trials for each walking condition. Assistive gait with the CW improved local dynamic stability in the lower extremities (hip, knee, ankle) compared with RW and was not significantly different from NG. However, peak joint angles and stride characteristics in CW were different from NG. The PWB on the feet was lower with the RW (70.3%) compared to NG (82.8%) and CW (80.9%). This improved stability may be beneficial for the elderly and patients with impaired gait. However, increased PWB is not beneficial for patients during the early stages of rehabilitation.

Combined Hip Angle Variability and RPE Could Determine Gait Transition in Elite Race Walkers.

The aim of this study was to investigate the role of energy cost in locomotion, specifically the rate of perceived exertion and movement variability in gait transition for eight race walkers (RW) and seven nonrace walkers (NRW). We hypothesized that a group of correlated variables could serve as combined triggers. Participants performed a preferred transition speed (PTS) test, exhibiting a higher PTS for RW (10.35 ± 0.28 km/hr) than for NRW (7.07 ± 0.69 km/hr), because RW engaged in race walking before switching to running. None of the variables increased before transition and dropped in PTS, which challenged the hypothesis of a unique transition variable in gait transitions. Principal component analysis showed that combined hip angle variability and rate of perceived exertion could determine gait transitions in elite RW and NRW. Thus, human gait transition may be triggered by a pool of determinant variables, rather than by a single factor.

Walking index for spinal cord injury (WISCI): criterion validation.

STUDY DESIGN: Retrospective examination. OBJECTIVES: To compare the Walking Index for Spinal Cord Injury (WISCI) and current scales for their sensitivity to walking changes in subjects with a spinal cord lesion (SCL) and further validate the WISCI for use in clinical trails. SETTING: A large rehabilitation hospital in the center of Italy. PATIENTS AND METHODS: Retrospective review was performed on 284 patient records with an SCL. Measurements included neurological evaluation with Lower Extremity Motor Scores (LEMS) according to the American Spinal Injury Association (ASIA) and walking status assessed by Barthel Index (BI (0-15)), Rivermead Mobility Index (RMI (three levels)), Functional Independence Measure (FIM (1-7)), Spinal Cord Independence Measure (SCIM (0-8)), and WISCI (0-20). The WISCI is a 21-level hierarchical scale which incorporates gradations of physical assistance and devices required for walking. Improvement in walking is based on the change of scores from admission to discharge. Statistical analysis included Spearman rank correlation and chi2 test; P<0.05. RESULTS: There was a significant positive correlation between WISCI and other scales (WISCI and BI r=0.67, P<0.001; WISCI and RMI r=0.67, P<0.001; WISCI and SCIM r=0.97, P<0.001; WISCI and FIM r=0.7, P<0.001). The initial ASIA grade was predictive of mobility outcome on the WISCI: of the 78 ASIA A patients, only five achieved independent walking versus 4/17 ASIA B (P=0.02), 56/109 ASIA C (P<0.001) and 39/44 ASIA D (P<0.001). The correlation of LEMS to the WISCI was 0.58 (P<0.001). At discharge, patients were distributed into 12 WISCI levels versus four FIM, three BI, two RMI and five SCIM levels. The most frequent WISCI levels at discharge were 13 (walker, no braces or assistance), 16 (two crutches, no braces or assistance) and 20 (no devices or assistance). CONCLUSIONS: Similar correlation between the WISCI and the other scales indicates that all these measures address the same concept, mobility, which is a measure of concurrent validity. The correlation is not 100% because of conceptual differences (the WISCI incorporates gradations of physical assistance and devices required for walking while most of the other scales focus on burden of care or mobility in the environment). The WISCI is more detailed and appears more sensitive to walking recovery than the other scales, as demonstrated by our patients' score distribution at discharge. Within each of the most frequent WISCI levels (13, 16, 20) LEMS and other walking features varied; therefore the scale would benefit from further refinement based on speed, distance and energy cost.

Presentation on assistive technologies for the seating and mobility needs of persons with osteogenesis imperfecta.

Persons with Osteogenesis Imperfecta (OI) are often protected and sheltered because of the fragile nature of their bones. Regardless of the degree of OI. over protecting a person with OI can be just as devastating as fractured bones. It is important that persons with OI are given the opportunity to participate in a wide variety of activities to develop the experiential, physical, and sociological dimensions of their lives. Assistive technology can help to make this participation a reality. Assistive technology should help protect the person from fractures, provide support to assist with postural alignment, and stability so that function and comfort can be enhanced. Technologies such as contoured foam mattresses, seating supports, temperature regulation technologies, orthotic supports, walking and wheelchair mobility devices can enhance the quality of live of people with OI.