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Introduction: Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. Objective: This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. Methods: A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). Results: Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). Conclusion: In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to identify factors related to walking efficiency in the early postoperative period of total hip arthroplasty (THA). Methods: The subjects of this study were 18 women who had undergone unilateral THA 4 weeks before and 18 healthy women as control. Using a force plate and a 3-D motion analyser, we measured: 1) gait speed, stride length, cadence; 2) centre of mass displacement in the three directions; 3) asymmetry of the centre of mass movement in vertical direction; and 4) the total internal work per unit mass and distance walked (a negative index of walking efficiency). Results: Compared with healthy persons, THA patients showed significantly greater total internal work per unit mass and distance walked. The vertical centre of mass motion of the THA patients demonstrated an asymmetrical pattern. In THA patients, the stepwise multiple regression analysis selected the displacement and the asymmetrical vertical motion of centre of mass as the sole significant variable affecting walking efficiency (R2 = 0.81). Conclusions: Our findings indicated that rehabilitation programs that control the vertical movement of the centre of mass during gait are important to improve walking ability in the early post-operative phase after THA. [ABSTRACT FROM AUTHOR]

Background: An increase in the knee adduction moment is one of the risk factors of medial knee osteoarthritis. This study examined the relationship between knee adduction moment and self-reported pain and disability. We also investigated the influence of pain on the relationships between knee adduction moment and gait performance and disability. Methods: Thirty-eight Japanese women with medial knee osteoarthritis participated in this study (66.37years (41–79years)). Gait analysis involved the measurement of the external knee adduction moment impulse in the stance duration and during 3 subdivisions of stance. The total, pain and stiffness, and physical function Japanese Knee Osteoarthritis Measure scores were determined. Findings: The pain and stiffness, physical function, and total scores were positively correlated with the knee adduction moment impulses in the stance duration, and initial and second double support interval, and single limb support interval. The knee adduction moment impulse during the stance duration was related to the pain and stiffness subscale and gait velocity. The pain and stiffness subscale was related to the physical function subscale. Interpretation: Our results suggest that increasing in the knee adduction moment impulse, a proxy for loading on the medial compartment of the knee, is related to increased pain during weight-bearing activities such as walking, thereby restricting walking performance and causing disability by reducing gait velocity. Thus, the reduction in the knee adduction moment impulse during gait may result in pain relief and may serve as a conservative treatment option with disease-modifying potential. [Copyright &y& Elsevier]

We aimed to develop gait standards for gait parameters in school-aged Japanese children and assess age-related differences in gait patterns and parameters. Children aged 6-12 years (n = 424) were recruited from two elementary schools. An instrumented three-dimensional gait analysis system was used to record each child's gait kinematics, kinetics, and spatiotemporal parameters. Participants were subdivided into three age groups (Group A, 6-8 years; Group B, 9-10 years; and Group C, 11-12 years). LMS Chartmaker, version 2.54, was used to create a developmental chart for the gait pattern. The non-normalized step and stride lengths were significantly longer, and the cadence was lower in older children; however, the opposite outcome occurred when analyzing normalized data. Ankle moment differed significantly by age, and the maximum ankle moment was higher in older children than that in younger children. Furthermore, the hip and knee flexion angles during gait and the normalized spatiotemporal parameters of Japanese children aged 6-12 years differed by age and from those of children from other countries. The centile chart of the gait pattern is a useful tool for clinicians to assess developmental changes in the gait pattern and detect gait abnormalities in children., (© 2022. The Author(s).)

Aims/introduction: This study examined the association between body mass index (BMI) and the risk of sarcopenia in Japanese type 2 diabetes patients., Materials and Methods: Patients with type 2 diabetes who visited an outpatient clinic comprised the study's participants. Sarcopenia was defined using the definition of the Asian Working Group for Sarcopenia 2014. The area under the curve was examined for the presence of sarcopenia based on the receiver operating characteristic curve of BMI., Results: Among 1,137 patients, 210 were diagnosed with low grip strength, 78 with slow gait speed, 444 with low muscle mass and 142 with sarcopenia. The optimal cut-off point of BMI level for risk of sarcopenia was 24.4 kg/m 2 (area under the curve 0.729, 95% confidence interval 0.688-0.770, sensitivity 0.587, specificity 0.789). Furthermore, the receiver operating characteristic curve of BMI for sarcopenia did not significantly differ (P = 0.09) from that of gait speed, an established marker of sarcopenia. In both the male and female groups, there was no difference between the receiver operating characteristic curves of BMI and gait speed for sarcopenia. (P = 0.23 and P = 0.40, respectively)., Conclusions: These results suggest that a BMI <24 kg/m 2 among Japanese patients with type 2 diabetes could increase their risk of sarcopenia, the extent of which is equivalent to the risk for sarcopenia from slow gait speed in this study. Further prospective investigation, however, is required., (© 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Background and Purpose: Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective., Methods: Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention., Results: In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity., Conclusions: Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to investigate whether gait training using the Gait Exercise Assist Robot (GEAR) is more effective for improving gait ability than treadmill gait training in chronic stroke subjects., Design: Subjects were randomly assigned to either the GEAR group (n = 8) or treadmill group (n = 11). Both groups received a training program of 20 sessions (5 days/week). The 10-m walk test, Timed Up and Go (TUG) test, 6-min walk test, the Medical Outcome Study 8-item Short Form Health Survey (SF-8), and Global Rating of Change (GRC) scales were administered at baseline (week 0), completion of training (week 4), 1-mo follow-up (week 8), and 3-mo follow-up (week 16)., Results: Gait speed was significantly increased at completion of training and 1-mo follow-up compared with baseline in the GEAR group. Mean changes in TUG and 6-min walk were significantly greater in the GEAR group than in the treadmill group at completion of training compared to baseline. Furthermore, GRC scales were significantly increased at completion of training, 1-mo follow-up, and 3-mo follow-up compared with baseline in the GEAR group., Conclusion: This study suggests that gait training using GEAR was more effective for improving gait ability than treadmill among subjects with chronic stroke., Registration of Clinical Trials: This study was registered with the University Hospital Medical Information Network (No. UMIN000028042)., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Compared to the general population, elderly patients with cardiovascular disease have a higher prevalence of sarcopenia, and it shows an association with increased mortality risk. Although several studies have indicated that atherosclerosis may cause sarcopenia in community dwelling elderly subjects, the association between sarcopenia and atherosclerosis is not clear in patients with ischemic heart disease (IHD). The present study was performed to examine the association between muscle function and atherosclerosis in elderly patients with IHD. We reviewed the findings of 321 consecutive patients ≥ 65 years old with IHD. Three measures of muscle function were examined, i.e., gait speed, quadriceps isometric strength, and handgrip strength, just before hospital discharge. In addition, we measured intima-media thickness (IMT) as a parameter of arteriosclerosis. To investigate the association between sarcopenia and atherosclerosis, patients were divided into Group H (high), Group M (middle), and Group L (low) according to the tertiles of muscle function, and IMT was compared between the three groups. In addition, we considered the association between IMT thickening and muscle function. The mean age of the study population was 74.1 ± 6.0 years and 73.2% of the patients were men. IMT was compared between groups stratified according to gait speed and quadriceps isometric strength, and the results indicated that IMT was significantly lower in Group H than in Groups L and M (p < 0.05). In addition, gait speed and quadriceps isometric strength were associated with IMT thickening (p < 0.05). Parameters reflecting muscle function of the lower limbs are associated with atherosclerosis in patients with IHD.

Purpose: This trial aimed to validate the effectiveness of using the Gait Exercise Assist Robot (GEAR) in patients with hemiplegia after primary stroke., Methods: The study design was open-label randomized controlled trial. Twenty-six patients with hemiplegia after primary stroke admitted to the comprehensive inpatient rehabilitation wards were enrolled and randomized to a group using GEAR in gait training and a control group. The intervention period was 4 weeks. Evaluations were conducted at admission, during intervention period, 8 weeks from start of intervention, and at discharge. Primary outcome measure was improvement efficiency of Functional Independence Measure (FIM)-walk score (FIM-walk improvement efficiency) that was calculated at the time of achieving FIM-walk score 5 (supervision level) during the intervention period or as weekly gain in FIM-walk score during 4 weeks for those who did not achieve score 5., Results: FIM-walk improvement efficiency was .7 ± .4 in GEAR group and .4 ± .3 in control group, and was significantly higher in GEAR group (P = .01). The FIM-walk score gain after 4 weeks was significantly higher in the GEAR group (P = .01), but there were no significant differences between 2 groups after 8 weeks and at discharge., Conclusions: Gait training using GEAR for 4 weeks improved walking ability of subacute stroke patients. GEAR contributes to early improvement of walking ability probably by the knee flexion assist during swing phase on the paralyzed side thereby increasing the volume of training, and by the finely adjustable stance/swing assist mechanism for the paralyzed limb which optimizes the training difficulty level., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The gait variables that are related to the risk of incident dementia have not yet been clarified. To examine whether quantitative gait variables can predict incident dementia in older adults., Design: A prospective study., Setting: A community setting., Participants: The study included 4011 participants (54% women; mean age 72.2 years)., Measures: Gait speed, stride length, and stride length variability were measured at baseline. Dementia was prospectively confirmed from monthly updated medical records., Results: The mean follow-up duration was 42.8 months, and there were 245 incident cases of dementia. A receiver operating characteristic curve showed the cut-off value for each gait variable against incident dementia during follow-up using the Youden index (gait speed: 1.12 m/s; stride length: 1.15 m; stride length variability: 3.67%). Based on these cut-off values, Cox proportional hazards regression models showed that after adjusting for covariates, dementia was significantly related to slow gait speed [hazard ratio (HR) 1.49, 95% confidence interval (CI) 1.10-2.01, P = .011], short stride length (HR 1.77, 95% CI 1.29-2.41, P < .001), and high stride length variability (HR 1.58, 95% CI 1.20-2.08, P = .001). Similarly, in a subanalysis stratified by sex, all gait variables were significantly related to the rate of incident dementia during follow-up in both men and women (all P < .05)., Conclusions/implications: Reduced gait function was related to incident dementia, and this association was independent of sex. Quantitative and multifaceted gait variables are valuable for assessing dementia risk., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: Chronic kidney disease (CKD) is a risk factor for declining cognitive and physical function. However, the prevalence of mild cognitive impairment (MCI) and its relationship with physical function is not clear. Therefore, our aim was to evaluate the prevalence of MCI and the relationship between MCI and physical function among older adults with pre-dialysis CKD., Methods: We conducted a cross-sectional study of 120 patients, aged ≥65 years (mean age, 77.3 years), with pre-dialysis CKD but without probable dementia (Mini Mental State Examination <24). MCI was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). For analysis, patients were classified into two cognitive function groups: normal (MoCA-J ≥ 26) and MCI (MoCA-J < 26). Physical, clinical, and biochemical parameters were compared between the groups. Logistic and linear regression analyses were used to evaluate the specific association between cognitive and physical function., Results: Seventy-five (62.5%) patients belonged to the MCI group. Significant differences between the two groups were identified for gait speed, balance, age, and haemoglobin concentration. After adjustment for covariates, only gait speed was significantly associated with MCI (odds ratio, 0.06; 95% confidence interval, 0.009-0,411)., Conclusion: The prevalence of MCI among older adults with pre-dialysis CKD was as high as 62.5%. The association between MCI and reduced gait speed supports the possible interaction between physical and cognitive functions and the need for early screening., (© 2017 Asian Pacific Society of Nephrology.)