Search

Background: Individuals after stroke walk with different step parameters and consequently with different margins of stability compared to able-bodied peers. These differences might be a side effect of lower preferred walking speeds or primary limitations in regulating step parameters and margins of stability after stroke., Methods: Twenty-eight individuals after stroke (separated into more impaired and less impaired based on speed) and fourteen able-bodied peers completed five walking trials on an instrumented treadmill at 70 %, 85 %, 100 %, 115 %, and 130 % of their preferred speed. Center of pressure data were used to calculate stride frequency, stride length, step width and margins of stability in mediolateral and anteroposterior direction. Generalized estimation equations were used to analyze the (interaction) effects of group, speed, and most versus least affected leg on these parameters., Findings: When controlled for speed, all individuals after stroke walked with higher stride frequencies (P < 0.001) and shorter stride lengths (P < 0.001) than able-bodied peers. Less impaired individuals walked with larger step widths than able-bodied peers (P < 0.001). The interaction effect of group and speed suggested that individuals after stroke showed higher increases in stride length with increasing speed than able-bodied peers. When controlled for speed, mediolateral margins of stability were larger in less impaired individuals compared to able-bodied peers, but otherwise, margins of stability did not differ between groups. Only minor differences between the most and least affected leg were observed., Interpretation: Differences in step parameters between individuals after stroke and able-bodied peers seem independent of walking speed and function to enhance gait stability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses., Method: A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles., Results: Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies., Conclusion: Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals., (© 2024. The Author(s).)

Aim: To obtain insights into the effects of fatigue on the kinematics, kinetics, and energy cost of walking (ECoW) in children with cerebral palsy (CP)., Method: In this prospective observational study, 12 children with CP (mean age 12 years 9 months, SD 2 years 7 months; four females, eight males) and 15 typically developing children (mean age 10 years 8 months, SD 2 years 4 months; seven females, eight males) followed a prolonged intensity-based walking protocol on an instrumented treadmill, combined with gas analysis measurements. The protocol consisted of consecutive stages, including a 6-minute walking exercise (6MW) at comfortable speed, 2 minutes of moderate-intensity walking (MIW) (with a heart rate > 70% of its predicted maximal), and 4 minutes walking after MIW. If necessary, the speed and slope were incremented to reach MIW. Outcomes were evaluated at the beginning and end of the 6MW and after MIW., Results: With prolonged walking, Gait Profile Scores deteriorated slightly for both groups (p < 0.01). Knee flexion increased during early stance (p = 0.004) and ankle dorsiflexion increased during late stance (p = 0.034) in children with CP only. Negligible effects were found for kinetics. No demonstrable change in ECoW was found in either group (p = 0.195)., Interpretation: Kinematic deviations in children with CP are progressive with prolonged walking. The large variation in adaptations indicates that an individual approach is recommended to investigate the effects of physical fatigue on gait in clinical practice., (© 2023 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)

Background: Muscle fatigue of the lower limbs is considered a main contributor to the perceived fatigue in children with cerebral palsy (CP) and is expected to occur during prolonged walking. In adults without disabilities, muscle fatigue has been proposed to be associated with adaptations in complexity of neuromuscular control., Research Question: What are the effects of prolonged walking on signs of muscle fatigue and complexity of neuromuscular control in children with CP?, Methods: Ten children with CP and fifteen typically developing (TD) children performed a standardised protocol on an instrumented treadmill consisting of three stages: six-minutes walking at preferred speed (6 MW), moderate-intensity walking (MIW, with two minutes at heart rate > 70% of predicted maximal heart rate) and four-minutes walking at preferred speed (post-MIW). Electromyography (EMG) data were analysed for eight muscles of one leg during three time periods: 6 MW-start, 6 MW-end and post-MIW. Signs of muscle fatigue were quantified as changes in EMG median frequency and EMG root mean square (RMS). Complexity of neuromuscular control was quantified by total variance accounted for by one synergy (tVAF1). Muscle coactivation was assessed for antagonistic muscle pairs., Results: EMG median frequency was decreased at 6 MW-end and post-MIW compared to 6 MW-start in children with CP (p < 0.05), but not in TD children. In both groups, EMG-RMS (p < 0.01) and muscle coactivation (p < 0.01) were decreased at 6 MW-end and post-MIW compared to 6 MW-start. tVAF1 decreased slightly at 6 MW-end and post-MIW compared to 6 MW-start in both groups (p < 0.05). Changes were most pronounced from 6 MW-start to 6 MW-end., Significance: Children with CP presented signs of muscle fatigue after prolonged walking, while no effects were found for TD. Both groups showed minimal changes in tVAF1, suggesting signs of muscle fatigue are not associated with changes in complexity of neuromuscular control., (Copyright © 2022. Published by Elsevier B.V.)

Background: Energy cost of walking (ECw) is an important determinant of walking ability in people with a lower-limb amputation. Large variety in estimates of ECw has been reported, likely because of the heterogeneity of this population in terms of level and cause of amputation and walking speed., Objectives: To assess (1) differences in ECw between people with and without a lower-limb amputation, and between people with different levels and causes of amputation, and (2) the association between ECw and walking speed., Study Design: Systematic review and meta-analysis., Methods: We included studies that compared ECw in people with and without a lower-limb amputation. A meta-analysis was done to compare ECw between both groups, and between different levels and causes of amputation. A second analysis investigated the association between self-selected walking speed and ECw in people with an amputation., Results: Out of 526 identified articles, 25 were included in the meta-analysis and an additional 30 in the walking speed analysis. Overall, people with a lower-limb amputation have significantly higher ECw compared to people without an amputation. People with vascular transfemoral amputations showed the greatest difference (+102%) in ECw. The smallest difference (+12%) was found for people with nonvascular transtibial amputations. Slower self-selected walking speed was associated with substantial increases in ECw., Conclusion: This study provides general estimates on the ECw in people with a lower-limb amputation, quantifying the differences as a function of level and cause of amputation, as well as the relationship with walking speed., (Copyright © 2021 International Society for Prosthetics and Orthotics.)

Objectives: Type 1 laryngeal cleft (T1LC) is a congenital deficiency in the posterior glottis, resulting in a communication between the hypopharynx and glottis. No consensus treatment paradigm exists for timing and criteria for patient selection for surgical repair. Our goal is to assess whether patient characteristics can help predict improvement after surgery., Methods: After Institutional Review Board exemption, a retrospective chart review was performed for patients undergoing surgery to diagnose a T1LC. Charts were examined for age, presenting symptoms, comorbidities, pre/postoperative videoflouroscopic swallow study reports, and outcomes., Results: Ninety-seven patients with clinical suspicion for T1LC underwent direct laryngoscopy and bronchoscopy, and 63 (64%) were diagnosed with a T1LC. Twenty-two patients (63%) undergoing surgery achieved clinical or radiographic improvement. There was no difference in average age, aspiration, or penetration between clinical improvement and no improvement groups. Of 13 patients with comorbidities that increase their risk of aspiration, 12 were significantly improved. There were 5 complications, which were managed conservatively., Conclusions: Our experience supports the repair of T1LC repair at time of diagnostic laryngoscopy if satisfactory improvement is not noted with conservative treatment. This should be performed without segregation for age, comorbidities, or degree of dysphagia. Our technique is performed with minimal complications and achieves satisfactory results.

Objective: To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with occult submucous cleft palate and to use the MRI information obtained to aid in the treatment decision to perform surgery versus behavioral speech therapy., Design: Prospective study with magnetic resonance (MR) images of subjects suspected of having occult submucous cleft palate., Setting: Hospital and university-based., Patients: Two girls who were 4 years old at the time of palatal surgery., Intervention: Furlow double-opposing Z-plasty., Main Outcome Measures: MR images and clinical speech evaluations., Results: MR images provided evidence of an interruption of levator veli palatini muscle tissue in the midline and a substantial attachment of levator muscle tissue to the posterior border of the hard palate. In addition, MR images for both subjects demonstrated remarkably similar bilateral encapsulating sheaths that contained nonmuscular tissue, as confirmed subsequently during surgery. The encapsulating sheaths interrupted the normal progression of the levator muscle sling across the midline. The MR images led to the decision to perform surgery instead of speech therapy. Hypernasality was markedly reduced in both subjects after surgery., Conclusions: MRI is an effective technique for diagnosing occult submucous cleft palate and may be an important aid in the treatment decision regarding surgery versus behavioral speech therapy for patients diagnosed with occult submucous cleft palate.

Background: This study developed and used a new, noninvasive approach to quantify cross-sectional area and tissue composition within the geniohyoid (GH) muscle in normal adults and head and neck cancer patients., Methods: B-mode ultrasound was used to measure GH cross-sectional area at rest and during four speech gestures and GH tissue composition at rest in normal young adults, patients with SCC head and neck cancer treated with primary radiotherapy, and normal older adults age matched with the patients., Results: Patients exhibited significantly greater GH cross-sectional area than young subjects at rest and in effortful conditions. Significantly greater muscle tissue variability across GH quadrants was observed in patients compared with normal subjects and in older compared with younger subjects., Conclusions: B-mode ultrasound area analyses and tissue classification techniques can be used to quantify muscle changes, such as those resulting from age, radiotherapy, or rehabilitation for head and neck cancer., (Copyright 2001 John Wiley & Sons, Inc.)

In order to advance our understanding of the relation between respiration and deglutition, simultaneous videofluoroscopy and respirodeglutometry was performed. Fifteen normal, healthy, young adults (20-29 years of age) were connected to a respirodeglutometer and positioned for simultaneous videofluoroscopic assessment in the lateral plane. Subjects performed three swallows each of a 5-ml and a 10-ml bolus of liquid barium and a 5-ml bolus of paste barium, for a total of nine swallows per subject. Location of the bolus head as identified with videofluoroscopy was associated with eight respirodeglutometric variables. In addition, temporal relations for seven respirodeglutometric variables were calculated as a function of bolus volume and viscosity. Significant temporal differences were found for five of the variables by volume. No significant temporal differences were noted by viscosity. Expiration occurred before 79% and after 96% of the swallows. The number of inspirations preceding a swallow suggested a possible effect resulting from the need to hold a bolus in the mouth before receiving instructions to swallow during videofluoroscopic assessment. This effect may be important during patient evaluation. For a significant number of swallows, respiratory flow ceased before the velum was fully elevated.

This study was designed to re-examine the same soft palates studied qualitatively in a previous investigation (Kuehn and Kahane, 1990), using a true-color image analysis system. The quantified measures of the areas of specific tissue types are reported. The results indicate that: (a) tendinous tissue is prominent anteriorly and comprises about 10% of total tissue in that region, (b) the relative proportion of glandular and connective tissue is fairly uniform across the length of the soft palate, averaging 22% and 36% respectively, (c) muscle tissue shows a pattern of increasing then decreasing amount from anterior to posterior with a maximum proportion of 23% in the midportion of the soft palate, (d) adipose tissue comprises 22% of total tissue area in the anterior segment and 17% of total tissue area in the posterior segment of the soft palate, (e) other tissue, primarily epithelium and vascular tissue, was found to be fairly constant anteriorly and increased in relative proportion to almost 30% of the total tissue area at the uvular base. The functional implications of these findings are discussed.