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Objectives: To investigate the potential benefits from lightly touching an external supporting device on automatic postural responses to support surface translations, in subjects with profound sensory neuropathy in the feet [...]

OBJECTIVE: To test the feasibility and efficacy of a home-based motor imagery gait training program to improve walking performance of individuals with chronic poststroke hemiparesis. DESIGN: Nonrandomized controlled trial. SETTING: Local facility. PARTICIPANTS: Participants (N=17) were community-dwelling volunteers with hemiparesis caused by a unilateral stroke that occurred at least 3 months before the study. INTERVENTION: Participants received 15 minutes of supervised imagery gait training in their homes 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training. Walking ability was evaluated by kinematics and functional scales twice before the intervention, 3 and 6 weeks after the intervention began, and at the 3-week follow-up. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and functional walking measurements. RESULTS: Walking speed increased significantly by 40% after training, and the gains were largely maintained at the 3-week follow-up. The effect size of the intervention on walking speed was moderate (.64). There were significant increases in stride length, cadence, and single-support time of the affected lower limb, whereas double-support time was decreased. Improvements were also noted on the gait scale of the Tinetti Performance-Oriented Mobility Assessment as well as in functional gait. Sixty-five percent of the participants advanced 1 walking category in the Modified Functional Walking Categories Index. CONCLUSIONS: Although further study is recommended, the findings support the feasibility and justify the incorporation of home-based motor imagery exercises to improve walking skills for poststroke hemiparesis. Copyright © 2008 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE: The application of motor imagery practice in the treatment of Parkinson's disease (PD) is a novel treatment approach for improving motor function. The purpose of this study was to compare group treatment using a combination of physical and motor imagery practice with group treatment using only physical practice in subjects with PD. METHODS: Of 23 patients with idiopathic PD, 12 received combined therapy, whereas 11 received physical therapy alone. Exercises for both groups were applied during 1-h sessions held twice a week for 12 weeks. Comparable motor tasks provided to both groups included callisthenic exercises, functional tasks, and relaxation exercises. However, the experimental group was treated with both imagery and real practice, whereas the control group received only physical exercises. Outcome measures included the time required to complete sequences of movements, the performance of balance tasks, impairment and functional scores on the Unified Parkinson's Disease Rating Scale (UPDRS), and specific cognitive abilities (Stroop and clock drawing tests). RESULTS: Following the intervention, the combined treatment group exhibited significantly faster performance of movement sequences than the control group. In addition, the experimental subjects demonstrated higher gains in the mental and motor subsets of the UPDRS and in the cognitive tests. Both groups improved on the activities of daily living scale. CONCLUSIONS: The combination of motor imagery and real practice may be effective in the treatment of PD, especially for reducing bradykinesia. The implementation of this treatment regimen allows for the extension of practice time with negligible risk and low cost. [ABSTRACT FROM AUTHOR]

The aim of this series of pilot case studies was to examine the feasibility of enhancing the walking of individuals with post-stroke hemiparesis through the imagery practice of gait activities at home. Four persons with chronic hemiparesis received imagery gait practice, 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training. Pre-intervention, mid-term, post-intervention and follow-up evaluations were performed. At 6 weeks from the beginning of treatment, the participants increased walking speed, stride length, cadence and single-support time on the affected lower limb, while decreasing double-support time. The findings appear to justify the institution of a larger-scale study in order to better delineate the contribution of motor imagery practice to gait performance in individuals with post-stroke hemiparesis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In subjects with unilateral vestibular malfunction, running is associated with less departure from the straight-ahead path than walking. The purpose of this study was to broaden the scope of these observations by investigating whether they can be generalized to healthy subjects. DESIGN: Healthy blindfolded subjects were asked to traverse a 10-m straight path while walking at a self-selected slow speed, walking at a fast speed, or running. Gait speed and mediolateral feet placement were monitored, and departure from the straight-ahead path (path integration) was determined. RESULTS: In healthy subjects, similar to subjects receiving unbalanced vestibular information, departures from the straight-ahead trajectory (namely, path integration) were larger in slow walking than in running. CONCLUSIONS: In healthy subjects, variation in foot placement between the acts of walking and running seem to account for the enhanced path integration found during running. Perhaps consideration of these findings is also relevant for the interpretation of speed-dependent path integration in subjects receiving abnormal unilateral vestibular inputs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective was to examine the associations between impairments of the paretic limb, locomotor capacities and kinematic variables in the frontal plane during walking. DESIGN: Cross-sectional study. SUBJECTS: Ten community-dwelling individuals with chronic hemiparesis due to a cerebrovascular accident. METHODS: Frontal plane kinematics of the shoulders and pelvis were assessed during treadmill walking in a gait lab using a videographic system to obtain the lateral displacements and lateral accelerations. The percentages of time spent in single stance were determined with foot-switches. Index of asymmetry for the lateral accelerations and single stance were also calculated. Subject motor and functional characteristics were measured by standardised clinical tests. RESULTS: Correlation analyses with Pearson product-moment correlation or Spearman's rank correlation revealed that, except for spasticity, the clinical scores were moderately to strongly associated with frontal kinematics and the single stance. In the multiple step-wise regression analysis, only the pelvic lateral displacements and the index of asymmetry in single stance were explained at more than 70% by the clinical scores with the Time Up and Go test explaining a high proportion of the total variance of these frontal parameters. CONCLUSION: Findings demonstrated associations between physical impairments, locomotor capacities and the frontal kinematics in adults with chronic stroke. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the effects of conventional over-ground gait training with treadmill training on the restoration of gait in people with hemiparesis following a stroke. Twenty-five individuals in the early stages of rehabilitation were alternately assigned to one of two treatment groups. In addition to conventional physical therapy, the experimental group participated in 15 treadmill-training sessions in which a handrail was used for external support. The control group received the same number of equal length sessions of over-ground ambulation. Treatment effects were established by pre- and posttreatment assessment of: 1) functional walking ability, 2) walking speed, 3) stride length, 4) temporal characteristics of gait, and 5) electromyographic activity of calf muscles. Normal values were obtained from eight healthy individuals of approximately the same age as the stroke survivors. The study demonstrates that individuals following a stroke are well able to tolerate treadmill training in the early stage of their rehabilitation process without the use of a weight support apparatus. Furthermore, the findings suggest that treadmill training may be more effective than conventional gait training for improving some gait parameters such as functional ambulation, stride length, percentage of paretic single stance period, and gastrocnemius muscular activity. [ABSTRACT FROM AUTHOR]

Objective: To examine and compare the effect of stepping on stairs of various heights on lower extremity weight bearing in hemiparetic patients. Setting: Flieman Geriatric Rehabilitation Hospital, Haifa, Israel. Subjects: Fifteen ambulatory hemiparetic patients following an acute cerebrovascular accident, and 16 age-matched healthy controls. Interventions: Each subject was tested twice on two consecutive days in five weight-bearing positions which included level stance and stepping with either leg on 10-cm- and 17-cm-high steps. Data concerning weight distribution on the lower extremities were collected by two computerized forceplates. Main outcome measure: Weight borne by each foot expressed as percentage of overall body weight. Results: In the attempted symmetrical level stance, the percentage of body weight borne by the paretic limb of the stroke patients was significantly lower than that of the nonparetic limb. Placing one foot on a step induced a weight shift to the foot placed on the floor regardless of step height. Weight shifting to the paretic limb was, however, significantly lower than to the nonparetic limb. Weight shifting to the nonparetic limb was significantly lower than to the corresponding limb of healthy individuals. Step height had no significant effect on weight distributions on the feet. Conclusions: Raising a foot on a step appears to be an appropriate strategy for weight shift training of stroke patients. Since weight shifting to both the paretic and nonparetic limb of stroke patients is impaired, treatment strategies should include training in weight shifting to both lower extremities. [ABSTRACT FROM AUTHOR]

The objective of this work was to study patients' self-appraisal of total knee arthroplasty (TKA) 6 and 12 months postoperatively, and to establish which factors determine dissatisfaction from surgery. The study group consisted of 79 patients subjected to TKA who underwent rehabilitation in a specialized institution from which they were discharged home after becoming independently ambulatory and capable of independent home care. Data were collected by interviews and physical examinations which were conducted upon admission to the rehabilitation program and at the patients' homes 6 and 12 months postoperatively. Descriptive statistics and logistic regression were applied for data analysis. Results of the 1-year follow-up indicated a decrease in the prevalence of pain in the postoperated knee and improvement in ambulatory capacities. The frequency of reliance on a walking aid and the prevalence of pain in the nonoperated knee were not substantially changed, however. In 27% of the subjects pain in the nonoperated knee had worsened at 1 year. One third of the respondents expressed dissatisfaction from the operation. Outcomes of the logistic regression analysis pointed to pain in both the ipsi- and contralateral knee and to the limitations in using stairs as the variables which significantly affected the levels of dissatisfaction 1 year postoperatively. Dissatisfaction could have resulted from inappropriate expectations from either misinterpretations or limited prior knowledge of the likely results of the operation. [ABSTRACT FROM AUTHOR]