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Objective. Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after participating in the Good Life With Osteoarthritis in Denmark (GLA:D) 8-week education and exercise program and assessed patient factors associated with improvement in difficulty walking. Methods. This was a registry-based cohort study of individuals in Denmark with knee OA who enrolled in GLA:D. Assessments were administered at baseline, program completion (~3 months), and 12 months. Our prespecified primary outcome was change in self-reported difficulty walking assessed using the EuroQol 5-dimension 5-level walking item. Exposures included sociodemographic factors, measures of OA illness severity, comorbidities, and psychological factors. In those with baseline moderate/severe difficulty walking, using multivariable regression analysis, we assessed the relationship between exposures of interest and improvement to no/slight difficulty walking. Results. We included 5262 participants. Of 2178 (41.4%) individuals with baseline moderate/severe difficulty walking, 51.4% and 58.3% reported no/slight difficulty walking at 3 and 12 months, respectively. Greater self-efficacy, younger age, female sex, lower BMI, less intense knee pain, and better function at baseline were associated with greater likelihood of improvement in difficulty walking, whereas severe difficulty walking at baseline and back pain intensity were associated with decreased likelihood of improvement. Conclusion. More than half of those with baseline difficulty walking experienced substantial improvement after completing GLA:D and this improvement was maintained at 12 months. Several patient factors were associated with the outcome, suggesting that some individuals may require additional support and extended treatment. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively and quantitatively evaluate the impact of body weight support training (BWST) on balance and gait function in stroke patients based on an evidence-based basis and to identify the most effective intervention strategies. Methods: PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and Chinese SinoMed Database were searched until November 25, 2023. Quality assessment and meta-analysis were performed using RevMan 5.2 and Stata 14.0 software. Results: A total of 31 randomized controlled trials involving 1,918 patients were included in the study. The meta-analysis demonstrated that body weight support training (BWST) significantly improved Berg Balance Scale (BBS) scores (MD = 3.60; 95% CI: 1.23 to 5.98; p = 0.003), gait speed (SMD = 0.77; 95% CI: 0.38 to 1.15; p < 0.0001), and step length (SMD = 0.46; 95% CI: 0.19 to 0.72; p = 0.0008) in stroke patients compared to conventional rehabilitation. For enhancing balance function, the most effective interventions were identified as a disease duration of 3-6 months (MD = 5.16; 95% CI: 0.76 to 9.57; p = 0.02), intervention time of 4-8 weeks (MD = 5.70; 95% CI: 2.90 to 8.50; p < 0.0001), a maximum body weight support level above 30% (MD = 3.80; 95% CI: 1.48 to 6.13; p = 0.001), and a maximum training walking speed of 0.2 m/s or more (MD = 4.66; 95% CI: 0.37 to 9.70; p = 0.03). For improving walking function, the optimal interventions were also a disease duration of 3-6 months (gait speed: SMD = 0.59; 95% CI: 0.15 to 1.03; p = 0.008; step length: SMD = 0.27; 95% CI: 0.06 to 0.56; p = 0.04), intervention time of 4-8 weeks (gait speed: SMD = 1.01; 95% CI: 0.44 to 1.59; p = 0.0006; step length: SMD = 0.83; 95% CI: 0.54 to 1.12; p < 0.00001), a maximum body weight support level above 30% (gait speed: SMD = 0.79; 95% CI: 0.36 to 1.22; p = 0.0003; step length: SMD = 0.79; 95% CI: 0.47 to 1.11; p < 0.00001), and a maximum training walking speed of 0.2 m/s or more (gait speed: SMD = 1.26; 95% CI: 0.62 to 1.90; p = 0.0001; step length: SMD = 0.85; 95% CI: 0.38 to 1.31; p = 0.0003). Conclusion: Compared with conventional rehabilitation training, BWST demonstrates superior efficacy in enhancing balance and walking function in stroke patients, with a consistent optimal intervention strategy. The most effective program includes a disease duration of 3-6 months, an intervention period of 4-8 weeks, a maximum body weight support of 30% or more, and a maximum training walking speed of 0.2 m/s or greater. [ABSTRACT FROM AUTHOR]

Objective：To explore the effect of lower limb exoskeleton robot gait training on walking function and gait in children with spastic diplegia cerebral palsy. Method：A total of 21 cerebral palsy children with spastic diplegia who visited the Rehabilitation Department of the Children's Hospital Affiliated to Zhejiang University Medical College from August 2022 to January 2023 were recruited as the treatment group. A matched control group of 21 children was selected based on age, gender, and functional status. Both groups underwent 8 weeks of conventional motor rehabilitation training (including exercise therapy, suspension training, and isokinetic strength training) five times per week. The treatment group additionally received lower limb exoskeleton robot gait training. Before and after 8-week treatment, the 6-minute walk test (6MWT), the Gross Motor Function Measure (GMFM-88) in domains D and E, and gait parameters such as walking of the children such as gait speed, stride frequency, stride length, and support phase duration was evaluated using the IDEEA motion capture system. Result：There was no significant difference (P>0.05) between the two groups of children in terms of 6MWD, GMFM-88 D-zone score, E-zone score, stride speed, stride frequency, stride length, and the proportion of bilateral support phase before treatment. After treatment, both groups showed improvements in 6MWD, GMFM-88 domain D and E score, stride speed, stride frequency, and stride length, while the proportion of bilateral support phase decreased. However, there were no significant differences between the groups in these post-treatment parameters (P>0.05). There were significant differences between groups in 6MWD difference (P<0.01), GMFM-88 domain D score (P<0.01), domain E score (P<0.01), stride speed difference (P<0.05), stride length difference (P<0.05), and bilateral support ratio difference (P<0.01) before and after treatment. The improvement in the treatment group was better than that in the control group. Conclusion：The combination of exoskeleton robot training and routine rehabilitation therapy can effectively improve walking function and gait in children with spastic cerebral palsy. [ABSTRACT FROM AUTHOR]

BACKGROUND: There have been many studies on biofeedback therapy and three-dimensional gait function analysis for chronic non-specific low back pain at home and abroad, but few studies on the combination of the two have been reported. OBJECTIVE: To study the effect of biofeedback assisted electrical stimulation on the change of walking ability in chronic non-specific low back pain by collecting gait parameter data through three-dimensional gait analysis. METHODS: Sixty patients with chronic non-specific low back pain, 34 males and 26 females, aged 32-58 years, were selected and admitted to First Affiliated Hospital of Guangdong Pharmaceutical University from June 2021 to September 2022. They were divided into control group (n=30) and trial group (n=30) according to the principle of random allocation. Both groups of patients received conventional treatment of dynamic interference with the waist, 20 minutes/ time, once/day, 5 times a week, for 20 times. The control group received supine bypass and prone bypass suspension core muscle training on the basis of conventional treatment, 5 times a week, for 20 times. The trial group received biofeedback assisted electrical stimulation therapy on the basis of the control group, 20 minutes/ time, once/day, 5 times a week, for 20 times. The low back pain score, the mean value of electromyography and the gait parameters were compared and analyzed before and after treatment between the two groups. RESULTS AND CONCLUSION: (1) After treatment, the numerical rating scale score, Japanese Orthopaedic Association score, and Oswestry disability index of the two groups were significantly improved compared with those before treatment (P < 0.05). Numerical rating scale score, Japanese Orthopaedic Association score, and Oswestry disability index of the trial group were better than those of the control group (P < 0.05). (2) After treatment, the mean values of surface electromyography of rectus abdominis, gluteus maximus, and erector spinae muscle in the two groups were higher than those before treatment (P < 0.05), and the mean values of surface electromyography of rectus abdominis, gluteus maximus, and erector spinae muscle in the trial group were higher than those in the control group (P < 0.05). (3) After treatment, the step width, step speed, step frequency, step length ratio between healthy and diseased sides, the relative value of support between healthy and diseased sides, the relative value of swing between diseased and healthy sides, the sagittal motion range of hip joint and knee joint between healthy and diseased sides and the foot angle between healthy and diseased sides were all better than those before treatment in both groups (P < 0.05). The above indexes of the trial group were better than those of the control group after treatment (P < 0.05). (4) These results suggest that biofeedback assisted electrical stimulation can significantly alleviate chronic non-specific low back pain, and improve the lower limb walking function. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionAugmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke.To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke.The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS).Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093).The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of iTBS stimulation on walking function in patients with stroke. Methods Fifty patients with post-stroke walking dysfunction who met the inclusion criteria were selected for 3-week rehabilitation treatment, and were randomly divided into iTBS group) n = 25) and sham group) n = 25). The iTBS group was treated with conventional rehabilitation therapy combined with iTBS stimulation of contralesional cerebellum, and the sham group was treated with conventional rehabilitation therapy plus iTBS stimulation of contralesional cerebellum. Relevant indicators were analyzed before treatment and at 21 days of treatment. Lower limb motor function scores of the two groups were compared before and after treatment. Fugl-Meyer motor function lower limb activity score, Berg Balance Scale score, Brunnstrom stage) lower limb), hamstring/quadriceps) H/Q) on the affected side, Modified Barthel index ) MBI), gait analysis parameters, and TMS-MEP were used to evaluate the effectiveness of cerebellar iTBS in the rehabilitation of walking dysfunction after stroke. Results After 21 days of treatment, the improvements of Brunnstrom stage, Holden grade, Berg score, FMA score, 6-minute walking distance, NIHSS score and MBI score in iTBS group were significantly better than those in sham group) P < 0.05). After treatment, the H/Q in iTBS group was significantly higher thanbefore) P < 0.05), but there was no significant difference between the two groups) P > 0.05). Stride speed, stride frequency, stride width, single support phase on the affected side and GDI score in iTBS group were significantly improved compared with sham group) P < 0.05), and there was no significant difference in stride length between the two groups after treatment) P > 0.05). The Conclusion Contralesional cerebellar iTBS combined with routine rehabilitation could improve lower limb walking function and daily living ability of stroke patients. [ABSTRACT FROM AUTHOR]

Objective：To observe the effects of brain-computer interface （BCI) combined with GEO system® lower limb robot（G-EO)on the balance and walking function in stroke patients. Method：Forty stroke patients were recruited from Wuxi central rehabilitation hospital, randomly divided into a control group and an experimental group, with 20 cases in each group. The patients in the control group underwent lower limb active-passive bicycle training and G-EO training on the basis of conventional rehabilitation treatment. The patients in the experimental group underwent BCI training and G-EO training on the basis of conventional rehabilitation treatment. Patients in both groups were assessed using the Fugl-Meyer lower limb motor function scale （FMA- LE), the Berg balance scale （BBS), the tecnobody balance assessment system and the Gait Watch 3D gait analyzer before treatments and after 4 weeks of treatments. Result：Before treatment, there were no significant differences between the control group and the experimental group （P>0.05). After 4 weeks of treatment, the FMA-LE, BBS, elliptical area of pressure center motion, length of the pressure center trajectory, stability limit, cadence, gait cycle, stride, stride speed, step length symmetry ratio and maximum ankle dorsiflexion in both groups were significantly better than before treatment （P<0.05). Compared with the control group, the FMA- LE, BBS, elliptical area of pressure center motion, length of the pressure center trajectory, stability limit, cadence, gait cycle, stride, stride speed of the experimental group were significantly improved（P<0.05). Conclusion：The 4- weeks BCI combined with G- EO training can effectively improve the lower limb movement function, the balance and the walking ability of stroke patients, demonstrating immediate effects. [ABSTRACT FROM AUTHOR]

Objective：To explore the clinical efficacy of 1 week scale acupuncture combined with functional electrical stimulation on the walking and balance function in post-stroke patients. Method：This study was a parallel randomized controlled clinical trial study，involving 36 qualified subjects， which were randomly divided into two groups：Scale acupuncture combined FES group，or FES group，with 18 patients in each group. Patients received routine rehabilitation intervention，and patients in the FES group was given additional FES treatment，and patients in scalp acupuncture combined with FES group were given additional scalp acupuncture and FES treatment， once a day， 30min each time，for 1 week. Changes in the walking function and balance function were evaluated before and after intervention. The Functional Ambulation Category Scale （FAC），Time up and go test （TUG），the 10 Meters Walking Test （10MWT），and the 6 Minute Walk Test （6MWT） were used to evaluate the walking function. Under both eyes-open and eyes-closed trials， the center of pressure （COP） area and perimeter of body sway were used to evaluate the motor function. All adverse events will be recorded. Result：All 36 participants completed the intervention. ①Before the intervention，there were no significant differences in age，gender，BMI，MoCA scale scores，and FAC，TUG，6MWT，10 MWT and the COP between the two groups （P>0.05）. ②After 1 weeks of intervention， the results of intra- group comparison of walking function and balance function were higher in both two groups（P<0.05）. ③After 1 weeks of intervention， the results of inter-group comparison of balance function showed that the eyes-closed COP area and perimeter of scalp acupuncture combined FES group were significantly higher than that of the FES group （P< 0.05）. There was no significantly difference in walking function between the two groups （P>0.05）. ④There was no adverse event during the test flow. Conclusion：1 week scalp acupuncture combined with FES have potential protective effect on the walking function and balance function in post-stroke patients. The eyes-closed balance function of scalp acupuncture combined FES group was significantly improved than that of FES group. [ABSTRACT FROM AUTHOR]

BACKGROUND: No study has yet demonstrated the effect of lower limb gait rehabilitation robot treatment combined with acupuncture on stroke patients. OBJECTIVE: To explore the effect of acupuncture combined with lower limb gait rehabilitation robot on walking function in patients with hemiplegia after stroke. METHODS: Fifty-six patients with hemiplegia after stroke were enrolled and randomly divided into two groups. The control group received regular rehabilitation training and acupuncture therapy; the intervention group was additionally trained by AiWalker-I lower limb gait robot. Both groups received 5 sessions a week for 4 weeks. Walking function parameters were assessed before and after the 4-week treatment. RESULTS: There was no significant difference in all parameters between the two groups in baseline (P > 0.05). After 4 weeks of treatment, all parameters including the effectiveness of functional ambulation category (FAC), time up and go test (TUGT) time, Wisconsin gait scale (WGS) score, walking spatiotemporal parameters were all significantly improved in both groups with a significant better effect in the intervention group (P < 0.05). CONCLUSION: Acupuncture combined with lower limb gait rehabilitation robot training has a positive effect on correction of abnormal gait and improvement of walking ability of hemiplegic patients after stroke. [ABSTRACT FROM AUTHOR]

Objective：To explore the synchronization effect of whole-body vibration therapy combined with squat-up training on ambulation of patients with stroke. Method：40 stroke survivors who could walk independently with supervision or assistive devices, were recruited from the Department of Rehabilitation Medicine, Huashan Hospital Affiliated to Fudan University (Pudong Campus) and were randomly divided into the WBVT group and the control group. Both groups received conventional rehabilitation treatment for 40 minutes per day. The WBVT group was given additional whole-body vibration therapy while squat-up training for another 20 minutes a day. The control group added sham stimulation of standing on the vibration platform with no vibration for the same amount of time per day. At the beginning of enrollment and after 4 weeks intervention, participants received two times evaluation by the wearable three-dimensional gait assessment instrument for the function of walking, and the electromyographic signals of the rectus femoris and long head of the biceps femoris were collected by surface electromyography instrument and statistical analysis on the data before and after the intervention. Result：After 4 weeks intervention, the stride speed and stride length of both groups improved siginificanlty (P<0.05), while the WBVT group was better than the control group (P<0.05). The swing angle of knee (flexion or extention)in the WBVT group improved significantly after intervention compared with the control group. At the single leg support phase (SS) of affected side, the differences were found in the synergistic contraction rate of the rectus femoris and biceps femoris in the bilateral lower extremity of the WBVT group after the intervention (P<0.05). At the swing phase (SW) of affected side, the differences were found in the synergistic contraction rate of the rectus femoris and biceps femoris in the bilateral lower extremity between the two groups before and after the intervention (P<0.05), but the affected side of the WBVT group was better than that the control group after intervention (P<0.05). Conclusion：Whole-body vibration therapy combined with rhythmic squat-up synchronous training can improve the stride speed, stride length and synergistic contraction rate of lower limb muscles for better ambulation of patients with stroke. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with stroke frequently experience walking dysfunction. Core training can help improve balance and walking function in patients with stroke. However, core training movements in clinical practice are numerous and differently targeted. Therefore, this study will investigate the improvement of walking function in patients with combined diaphragmatic breathing maneuver (DBM) and draw-in breathing technique (ADIM) training. Methods This single-blind, randomized controlled preliminary will analyze the viability of DBM combined ADIM training versus routine rehabilitation therapy in patients with stroke with early to mid-stroke. Patients will be randomly assigned to either the DBM and ADIM training or the routine rehabilitation training. We will recruit 42 stroke inpatients from the Second Rehabilitation Hospital of Shanghai who meet the trial criteria and measure the balance and walking functions and improvement of that after 4 weeks of intervention. The primary outcome is the 10 m maximum walking test (10MWT). The secondary outcomes indices include the limits of stability test (LOS), Berg balance scale test (BBS), Functional Ambulation Categories test (FAC), Timed Up and Go test (TUG), trunk impairment scale test (TIS), ultrasound indicators of the diaphragm and transversus abdominis (UI), rhythmic weight shift test (RWS), walk across test (WA), Fugl-Meyer assessment of lower extremity (FMA-LE), and Barthel index of ADL test. Discussion The primary objective of this project was to investigate the effects of DBM combined with ADIM on balance capacity and walking function for patients with early to mid-stroke. The outcomes of this study will hold significant implications for future clinical applications in rehabilitation. Trial registration Chinese Clinical Trial Registry (ChiCTR), ID: ChiCTR2100054897. Registered on 28 December 2021.

Background: Patients with stroke frequently experience walking dysfunction. Core training can help improve balance and walking function in patients with stroke. However, core training movements in clinical practice are numerous and differently targeted. Therefore, this study will investigate the improvement of walking function in patients with combined diaphragmatic breathing maneuver (DBM) and draw-in breathing technique (ADIM) training. Methods: This single-blind, randomized controlled preliminary will analyze the viability of DBM combined ADIM training versus routine rehabilitation therapy in patients with stroke with early to mid-stroke. Patients will be randomly assigned to either the DBM and ADIM training or the routine rehabilitation training. We will recruit 42 stroke inpatients from the Second Rehabilitation Hospital of Shanghai who meet the trial criteria and measure the balance and walking functions and improvement of that after 4 weeks of intervention. The primary outcome is the 10 m maximum walking test (10MWT). The secondary outcomes indices include the limits of stability test (LOS), Berg balance scale test (BBS), Functional Ambulation Categories test (FAC), Timed Up and Go test (TUG), trunk impairment scale test (TIS), ultrasound indicators of the diaphragm and transversus abdominis (UI), rhythmic weight shift test (RWS), walk across test (WA), Fugl-Meyer assessment of lower extremity (FMA-LE), and Barthel index of ADL test. Discussion: The primary objective of this project was to investigate the effects of DBM combined with ADIM on balance capacity and walking function for patients with early to mid-stroke. The outcomes of this study will hold significant implications for future clinical applications in rehabilitation. Trial registration: Chinese Clinical Trial Registry (ChiCTR), ID: ChiCTR2100054897. Registered on 28 December 2021. [ABSTRACT FROM AUTHOR]

Objective To explore the effects of multichannel functional electrical stimulation (FES) combined with limb linkage training on lower limb motor function and walking function in stroke patients. Methods From April 2022 to January 2023,a total of 40 stroke patients admitted to the Department of Rehabilitation Medicine of the hospital were randomly divided into the routine group and the combined group, with 20 cases in each group. Both groups received regular rehabilitation training. The conventional group received limb linkage training, while the combined group received multichannel FES combined with limb linkage training. Before and after four weeks training, Fugl-Meyer lower extremity scale (FMA-LE),10-meter maximum walking speed (10 m MWS) and Timed Up and Go Test (TUGT) were used to evaluate the lower limb motor function and walking function of the two groups. Results After four weeks treatment, FMA-LE,10 m MWS and TUGT in both groups were significantly improved compared with those before treatment, and the score of FMA-LE in the combined group was significantly higher than that in the routine group, 10 m MWS was significantly faster than that in the routine group, and the TUGT was significantly shorter than that in the routine group, with statistically significant differences (P＜0. 05). Conclusion FES combined with limb linkage training can effectively improve the lower limb motor function and walking function of stroke patients. [ABSTRACT FROM AUTHOR]

Background: Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SREassisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. Methods: A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. Results: After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Conclusion: Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of Pro-kin balance device combined with lower limb intelligent feedback system training on balance and walking function in stroke patients with hemiplegia. Methods A total of 68 stroke hemiplegia patients admitted to the Department of Rehabilitation of this hospital from March to December 2022 for rehabilitation treatment were selected and divided into the control group and the study group by random number table method, with 34 cases in each group. Patients in both groups received routine rehabilitation training, the control group received lower limb intelligent feedback system training on the basis of routine rehabilitation training; the study group received Pro-kin balance instrument combined with lower limb intelligent feedback system training on the basis of routine rehabilitation training. Patients in both groups received training six times a week and received continuous treatment for six weeks. Berg Balance Scale (BBS), Fugl-Meyer Assessment of Lower Extremity (FMA-LE), and Gait Watch 3D gait analysis (stride speed, stride length, and stride width) were used to evaluate the balance and walking function of the two groups before and after treatment. Results There were no statistical significances in BBS score, FMA-LE score. Gait Watch 3D gait analysis between the two groups before treatment (P>0. 05). After six weeks of treatment, the BBS score.FMA-LE score, and Gait Watch 3D Gait analysis in both groups were significantly improved compared with before treatment, and the BBS score, FMA-LE score, and Gait Watch 3D gait analysis in the study group were significantly better than those in the control group after six weeks of treatment, with statistical significance (P<0.05). Conclusion The Pro-kin balance device combined with the lower limb intelligent feedback system helps improve the balance and walking function of stroke hemiplegia patients. [ABSTRACT FROM AUTHOR]

This study aims to explore the effects of aquatic strength training on the postural balance and walking function of stroke patients. A total of 56 chronic stroke patients more than 6 months post-stroke with walking and balance impairments were included in this study. After baseline evaluations, patients were randomly assigned to either the experiment group (n = 29) or control group (n = 27). Patients in the control group underwent conventional hydrotherapy, whereas patients in the experiment group received conventional hydrotherapy combined with aquatic lower extremity strength training. After six weeks of rehabilitation, all patients were evaluated by a blinded assessor, and the functional assessments including: Berg Balance Scale (BBS); Timed Up and Go Test (TUG and mTUG); 2 Minute Walk Test (2MWMT); and Gait analysis. There were no significant differences (P >.05) between the two groups in all evaluation indexes before rehabilitation. Six weeks after treatments, the results from both groups showed significant improvements compared with those in the baseline evaluations (P <.05). Notably, compared with the control group, BBS, TUG and mTUG, 2MWMT, and Gait analysis including stride length in the non-hemiplegic side, stride length, as well as walking speed and stride frequency in the hemiplegic side in experiment group were markedly improved (P <.05) Aquatic strength training can improve postural balance and lower extremity motor functions in chronic stroke patients. [ABSTRACT FROM AUTHOR]

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Objective: To analyze the correlation between balance function and gait parameters of patients with basal ganglia infarction. And to observe the influence of balance function on plantar pressure and hemiplegia gait based on the Berg Balance Scale (BBS) score. Methods: One hundred and forty patients with cerebral infarction hemiplegia in the basal ganglia region (a study group, n = 140) and healthy people (a control group, n = 140) were enrolled. The study group was evaluated with the BBS, the 10 m walking test (10MWT), and the timed up-and-go test (TUGT). The gait parameters and the peak plantar pressure were measured in both groups while walking, and the differences between the groups were compared. In addition, the characteristics of the plantar pressure curve of the hemiplegic and nonhemiplegic sides during walking and the correlation between the 10MWT, the TUGT, the plantar pressure peak, the gait parameters, and the BBS score were analyzed in the study group. Results: The peak plantar pressure of the forefoot and heel, stride length, lateral symmetry, stand phase, swing phase, and dual stand phase of both sides in the study group were significantly lower than those in the control group (P < 0.05). The BBS score negatively correlated with the 10MWT, the TUGT, the peak plantar pressure of the hemiplegic forefoot, midfoot, and the non-hemiplegic midfoot, the anterior to posterior position (ant/post position), hemiplegic stand phase, and the dual stand phase (P < 0.05). The BBS score positively correlated with the hemiplegic swing phase and stride length (P < 0.05). Conclusion: A correlation was found between the forefoot plantar pressure and the stand phase of the hemiplegic limbs, the ant/post position, and the balance function after basal ganglion cerebral infarction. This association can be used in walking and balance assessment for stroke rehabilitation. Correcting forefoot pressure or the front and ant/post position can improve balance function. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of virtual reality balance training combined with neuromuscular electrical stimulation (NMES) on knee function, hamstring muscle strength and walking function after anterior cruciate ligament reconstruction (ACLR). Methods: 96 patients with anterior cruciate ligament (ACL) injury who were treated in our hospital from August 2019 to December 2021 were selected, and ACLR was successfully implemented. They were randomly divided into control group (n=48, routine rehabilitation training, virtual reality balance training) and study group (n=48, outine rehabilitation training, virtual reality balance training combined with intervention) by random number table method. The excellent and good rate of knee function, knee function, hamstring muscle strength and walking function of the two groups were compared. Results: The excellent and good rate of knee joint function in the study group was 93.75% (45/48) higher than 68.75% (33/48) in the control group, and the difference was statistically significant (P<0.05). After intervention, knee function score and knee range of motion were increased in the two groups, and the study group was higher than the control group (P<0.05). After intervention, the isometric strength of the affected side hamstring muscle in the two groups increased, and the study group was higher than the control group (P<0.05). There was no significant difference in isometric strength of the unaffected side hamstring muscle in the two groups after intervention (P>0.05). After intervention, the step length and step speed in the two groups increased, and the study group was higher than the control group, the affected side swing phase decreased, and the study group was lower than the control group (P<0.05). After intervention, the threshold of passive activity perception and conduct passive angle regeneration test decreased in two groups, and the study group was lower than the control group (P<0.05). Conclusion: Virtual reality balance training combined with NMES has a significant effect on patients with ACLR after operation, which is helpful to the recovery of knee joint function, improve hamstring muscle strength and improve walking function. [ABSTRACT FROM AUTHOR]

Objective: After a stroke, patients usually suffer from dysfunction, such as decreased balance ability, and abnormal walking function. Wholebody vibration training can promote muscle contraction, stimulate the proprioceptive system, enhance the muscle strength of low limbs and improve motor control ability. The study aims to evaluate the effectiveness of wholebody vibration training on the balance and walking function of patients with stroke. Methods: PubMed, CNKI, VIP, CBM, EBSCO, Embase and Web of Science were searched. According to the inclusion and exclusion criteria, randomized controlled trials on the effectiveness of whole-body vibration training on the balance and walking function of patients with stroke were collected. The search time ranged from the date of database construction to November 2022. The included trials were evaluated by the Cochrane risk-of-bias tool. The meta-analysis was performed using two software packages, consisting of RevMan 5.4 and Stata 12.2. If the results included in the literature were continuous variables, use the mean difference (MD) and 95% confidence interval (CI) for statistics. Results: (1) A total of 22 randomized controlled trials (RCTs) with a total of 1089 patients were included. (2) The results of meta-analysis showed that: compared with the controls, step length (MD = 6.12, 95%CI [5.63, 6.62], p < 0.001), step speed (MD = 0.14, 95%CI [0.09, 0.20], p < 0.001), cadence (MD = 9.03, 95%CI [2.23, 15.83], p = 0.009), stride length (MD = 6.74, 95%CI [-3.47, 10.01], p < 0.001), Berg Balance Scale (BBS) (MD = 4.08, 95%CI [2.39, 5.76], p < 0.001), Timed Up-and-Go test (TUGT) (MD = -2.88, 95%CI [-4.94, 0.81], p = 0.006), 10-meter Walk Test (10MWT) (MD = -2.69, 95%CI [-3.35, -2.03], p < 0.001), functional ambulation category scale (FAC) (MD = 0.78, 95%CI [0.65, 0.91], p < 0.001), Fugl-Meyer motor assessment of lower extremity (FMA-LE) (MD = 4.10, 95%CI [2.01, 6.20], p = 0.0001). (3) The results of subgroup analysis showed that, compared with other vibration frequencies, at 20-30 Hz frequency, WBV training had an obvious improvement effect only in TUGT. (4) The safety analysis showed that WBV training may be safe. Conclusion: Whole-body vibration training has a positive effect on the balance and walking function of patients with stroke. Thus, whole-body vibration training is a safe treatment method to improve the motor dysfunction of patients with stroke. [ABSTRACT FROM AUTHOR]

[Display omitted] • Robot-assisted gait training improves walking function after stroke. • Small-worldness and network efficiency of the whole brain are reduced after stroke. • Robot-assisted gait training promotes normalization of whole-brain network. To investigate alterations of whole-brain network after stroke and therapeutic mechanisms of robot-assisted gait training (RAGT). 21 stroke patients and 20 healthy subjects were enrolled, with the stroke patients randomized to either control group (n = 11) or robot group (n = 10), and resting-state functional magnetic resonance imaging data were collected. The global network metrics were obtained using graph theory analysis and compared between stroke patients and healthy subjects, and the effect of the RAGT on the whole-brain networks was explored. Compared to healthy subjects, area under the curve (AUC) for small-worldness (σ), clustering coefficient (Cp), global efficiency (Eg) and mean local efficiency (Eloc) were significantly lower in stroke patients, whereas AUC for characteristic path length (Lp) were significantly higher. Compared with the control group, patients in robot group showed significant improvement in lower limb motor function, balance function and walking function after intervention, with a significant reduction in the AUC of Cp. Moreover, the improvement of walking function was positively correlated with the changes of AUC of σ and Eg, and negatively correlated with the changes of AUC of Cp. Small-worldness and network efficiency were significantly reduced after stroke, whereas RAGT decreased characteristic path length and promoted normalization of the whole-brain network, and this change was associated with improvement in walking function. Our findings reveal the mechanism by which RAGT regulates network reorganization and neuroplasticity after stroke. [ABSTRACT FROM AUTHOR]

In daily functional activities, the body needs the ability to perform two or more tasks at the same time (such as talking while walking). However, the gait disorder of patients with Parkinson's disease is aggravated when performing dual tasks, which seriously affects their quality of life. Therefore, the medical management plan should offer effective exercise training programming to improve Parkinson's disease patients' ability to perform dual tasks. Most traditional exercise intervention methods only focus on the perspective of exercise or cognition, ignoring their interaction, and fail to adequately resolve the dual task obstacles associated with Parkinson's disease. Some scholars put forward the concept of dual-task training and have applied dual-task training to patients with neurological disorders and have achieved good therapeutic effects. Therefore, this article summarizes the research literature concerning dual-task training to improve cognitive impairment and walking function of Parkinson's disease patients, to evaluate and discuss possible mechanisms of action, and provide a basis for adjuvant treatment and rehabilitation of Parkinson's disease patients.

BACKGROUND: The functional recovery of patients after total knee arthroplasty is not ideal. Routine rehabilitation pays more attention to the rehabilitation of the tissue around the knee joint, but neglects the training of the abductor muscle of the hip. There is a correlation between hip abductor and limb function of patients with total knee arthroplasty, but the specific effect remains to be studied. OBJECTIVE: To explore the effect of hip abductor training on balance and walking function recovery in patients with total knee arthroplasty. METHODS: From March 2020 to May 2021, 60 patients with unilateral total knee arthroplasty from Huadong Hospital Affiliated to Fudan University were randomly divided into trial group (n=30) and control group (n=30). The control group received conventional treatment. The trial group received conventional treatment and hip abductor training. Hip abductor isokinetic muscle strength, knee function score, single leg stance, Timed Up and Go test, and threedimensional gait analysis were assessed in both groups before and 4 weeks after treatment. RESULTS AND CONCLUSION: (1) The hip abductor isokinetic muscle strength was significantly higher in the trial group than that of the control group 4 weeks after treatment (P < 0.05). (2) At 4 weeks after treatment, Knee Society Score was significantly higher in the trial group than that of the control group (P < 0.05). (3) At 4 weeks after treatment, single leg stance time was significantly longer in the trial group than that in the control group; Timed Up and Go test time was significantly shorter in the trial group than that in the control group (P < 0.05). (4) At 4 weeks after treatment, the proportion of walking amplitude and affected side support phase was significantly better in the trial group than that in the control group (P < 0.05). (5) These findings have verified that early hip abductor training after total knee arthroplasty can increase hip abductor muscle strength and improve patients’ balance and walking function. However, its rehabilitation program and long-term efficacy still need further research. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of rehabilitation exercise training combined with transcranial direct current stimulation (t DCS) on walking function, balance function and cognitive function in patients with Parkinson's disease (PD). Methods: A total of 60 PD patients admitted to our hospital from May 2018 to May 2021 were selected and randomly divided into control group and study group with 30 cases in each group according to computer-generated data. The patients in the control group received rehabilitation exercise training, and the patients in the research group received rehabilitation exercise training combined with t DCS. Both groups were treated for two weeks. The changes in walking function, balance function, limb function, cognitive function and self-care ability were compared between the two groups. Results: After treatment, the stride speed, stride frequency and stride width of the study group were higher than those of the control group (P<0.05). The Berg Balance Scale (BBS) score in the study group was higher than that in the control group after treatment (P<0.05). The Montreal Cognitive Assessment Scale (MoCA) scores and total scores in the study group were higher than those in the control group after treatment (P<0.05). After treatment, the score of the third part of the Unified Parkinson's Disease Evaluation Scale (UPDRS-Ⅲ) in the study group was lower than that in the control group, and the modified Barthel index (MBI) score was higher than that in the control group (P<0.05). CONCLUSION: After rehabilitation exercise training combined with t DCS treatment, both motor and non-motor disorders can be significantly improved in PD patients, and the self-care ability is improved, and the clinical application value is high. [ABSTRACT FROM AUTHOR]

Objectives: Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Inconsistent associations between physical function and wandering behavior were reported, and the effect of cognitive decline may be different according to walking ability. The purposes of this study are to investigate whether high walking ability is a risk factor for wandering behavior and to investigate the interaction of walking ability and cognitive function with wandering behavior in older adults with dementia.Methods: This retrospective cohort study included 3979 elderly adults with dementia. The association of cognitive function and walking ability with incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction (RERI) was calculated.Results: Severe cognitive decline and high walking ability were associated with a higher risk for wandering behavior. Additionally, some joint effects of cognitive decline and walking ability decline were higher than the sum of its individual effects (RERI [95% confidence interval], severe cognitive decline × 'walk with help': 1.58 [0.35, 2.81]; severe cognitive decline × 'independent': 3.09 [1.05, 5.14]).Conclusions: Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the clinical effects of MOTOmed intelligent exercise training combined with intensive walking training on the rehabilitation of walking, nerve and lower limb functions among patients with hemiplegia after stroke. Methods: Randomized controlled trial was used in this study. Fifty-two patients with hemiplegia after stroke treated in 82nd Army Group Military Hospital from February 2017 to February 2018 were selected as the subjects and randomly divided into the control group and the observation group, each with 26 cases. The control group underwent intensive walking training, and the observation group underwent MOTOmed intelligent exercise training on the control group basis. Both groups' rehabilitation of walking function, nerve function and lower limb function were observed. Results: Both groups had significantly increased FAC score and 10-m maximum walking speed (P < 0.05), and the observation group had significantly higher results than those of the control group (P < 0.05); both groups had significantly higher FMA scores than before treatment (P < 0.05), and the observation group had significantly higher scores than those of the control group (P < 0.05); both groups after two months of treatment had significantly increased NGF, NT-3 and BDNF (P<0.05), and the observation group had significantly higher levels than those of the control group (P<0.05). Conclusion: MOTOmed intelligent exercise training combined with intensive walking training can significantly improve the walking function, nerve function and lower limb function among patients with hemiplegia after stroke. [ABSTRACT FROM AUTHOR]

Objective: The STarT Back Tool (SBT) predicts risk for persistent low back pain (LBP)-related disability based on psychological distress levels. Other non-psychological factors associated with LBP, such as pain sensitivity and physical performance, may further characterize SBT-risk subgroups. The purpose of this study was to determine whether a low-risk SBT subgroup demonstrated lower pain sensitivity and/or higher physical performance compared with a medium-/high-risk SBT subgroup. Methods: In this cross-sectional, secondary analysis, adults with LBP (N = 76) completed SBT and demographics (age, sex, race, chronicity) questionnaires. Participants underwent pain sensitivity (local and remote pressure pain thresholds, temporal summation, conditioned pain modulation) and physical performance (Back Performance Scale, walking speed, obstacle negotiation, Timed "Up & Go" [TUG], TUG Cognitive) testing. Independent samples t tests determined low- versus medium-/high-risk SBT subgroup differences. A follow-up discriminant function analysis was also conducted. Results: The medium-/high-risk subgroup demonstrated a lower proportion of participants with acute pain. The low-risk subgroup demonstrated lower pain sensitivity (higher local pressure pain thresholds and higher conditioned pain modulation) and higher physical performance (superior Back Performance Scale scores, faster walking speeds, faster obstacle approach and crossing speeds, and faster TUG completion). Discriminant function analysis results supported the 2-subgroup classification and indicated strong to moderate relationships with obstacle crossing speed, chronicity, and conditioned pain modulation. Conclusion: Lower pain sensitivity and higher physical performance characterized the low-risk SBT subgroup and may represent additional LBP prognostic factors associated with persistent disability. Longitudinal studies are needed to confirm whether these factors can enhance SBT prediction accuracy and further direct treatment priorities. Impact: Sensory and physical factors contribute to SBT risk classification, suggesting additional, non-psychological factors are indicative of favorable LBP outcomes. Findings highlight the need for assessment of multiple factors to improve LBP clinical prediction. Lay Summary: People at low risk for back pain disability have less sensitivity to pain and better physical performance. By measuring these factors, physical therapists could guide treatment and improve outcomes for people with back pain. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively and quantitatively evaluate the impact of body weight support training (BWST) on balance and gait function in stroke patients based on an evidence-based basis and to identify the most effective intervention strategies., Methods: PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and Chinese SinoMed Database were searched until November 25, 2023. Quality assessment and meta-analysis were performed using RevMan 5.2 and Stata 14.0 software., Results: A total of 31 randomized controlled trials involving 1,918 patients were included in the study. The meta-analysis demonstrated that body weight support training (BWST) significantly improved Berg Balance Scale (BBS) scores (MD = 3.60; 95% CI: 1.23 to 5.98; p = 0.003), gait speed (SMD = 0.77; 95% CI: 0.38 to 1.15; p < 0.0001), and step length (SMD = 0.46; 95% CI: 0.19 to 0.72; p = 0.0008) in stroke patients compared to conventional rehabilitation. For enhancing balance function, the most effective interventions were identified as a disease duration of 3-6 months (MD = 5.16; 95% CI: 0.76 to 9.57; p  = 0.02), intervention time of 4-8 weeks (MD = 5.70; 95% CI: 2.90 to 8.50; p  < 0.0001), a maximum body weight support level above 30% (MD = 3.80; 95% CI: 1.48 to 6.13; p  = 0.001), and a maximum training walking speed of 0.2 m/s or more (MD = 4.66; 95% CI: 0.37 to 9.70; p  = 0.03). For improving walking function, the optimal interventions were also a disease duration of 3-6 months (gait speed: SMD = 0.59; 95% CI: 0.15 to 1.03; p  = 0.008; step length: SMD = 0.27; 95% CI: 0.06 to 0.56; p  = 0.04), intervention time of 4-8 weeks (gait speed: SMD = 1.01; 95% CI: 0.44 to 1.59; p  = 0.0006; step length: SMD = 0.83; 95% CI: 0.54 to 1.12; p  < 0.00001), a maximum body weight support level above 30% (gait speed: SMD = 0.79; 95% CI: 0.36 to 1.22; p  = 0.0003; step length: SMD = 0.79; 95% CI: 0.47 to 1.11; p  < 0.00001), and a maximum training walking speed of 0.2 m/s or more (gait speed: SMD = 1.26; 95% CI: 0.62 to 1.90; p  = 0.0001; step length: SMD = 0.85; 95% CI: 0.38 to 1.31; p  = 0.0003)., Conclusion: Compared with conventional rehabilitation training, BWST demonstrates superior efficacy in enhancing balance and walking function in stroke patients, with a consistent optimal intervention strategy. The most effective program includes a disease duration of 3-6 months, an intervention period of 4-8 weeks, a maximum body weight support of 30% or more, and a maximum training walking speed of 0.2 m/s or greater., Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022358963., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jiang, Zhang, Fu and Tao.)

Objectives: The objective of this study was to explore the efficacy of cerebellar intermittent theta burst stimulation (iTBS) on the walking function of stroke patients. Methods: Stroke patients with walking dysfunction aged 25–80 years who had suffered their first unilateral stroke were included. A total of 36 patients [mean (SD) age, 53 (7.93) years; 10 women (28%)] were enrolled in the study. All participants received the same conventional physical therapy, including transfer, balance, and ambulation training, during admission for 50 min per day during 2 weeks (10 sessions). Every session was preceded by 3 min procedure of cerebellar iTBS applyed over the contralesional cerebellum in the intervention group or by a similar sham iTBS in control group. The groups were formed randomly and the baseline characteristics showed no significant difference. The primary outcome measure was Fugl–Meyer Assessment–Lower Extremity scores. Secondary outcomes included walking performance and corticospinal excitability. Measures were performed before the intervention beginning (T0), after the first (T1) and the second (T2) weeks. Results: The Fugl–Meyer Assessment for lower extremity scores slightly improved with time in both groups with no significant difference between the groups and over the time. The walking performance significantly improved with time and between group. Two-way mixed measures ANOVA showed that there was significant interaction between time and group in comfortable walking time (F 2,68 = 6.5242, P = 0.0080, η2partial = 0.276, ε = 0.641), between-group comparisons revealed significant differences at T1 (P = 0.0072) and T2 (P = 0.0133). The statistical analysis of maximum walking time showed that there was significant interaction between time and groups (F 2,68 = 5.4354, P = 0.0115, η2partial = 0.198, ε = 0.734). Compared with T0, the differences of maximum walking time between the two groups at T1 (P = 0.0227) and T2 (P = 0.0127) were statistically significant. However, both the Timed up and go test and functional ambulation category scale did not yield significant differences between groups (P > 0.05). Conclusion: Our results revealed that applying iTBS over the contralesional cerebellum paired with physical therapy could improve walking performance in patients after stroke, implying that cerebellar iTBS intervention may be a noninvasive strategy to promote walking function in these patients. This study was registered at ChiCTR, number ChiCTR1900026450. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of motor imagery therapy (MI) combined with neuromuscular proprioception facilitation (PNF) trunk mode training on upper limb function, walking function and trunk control ability of stroke patients with hemiplegia. Methods: 112 stroke patients with hemiplegia in the 983 Hospital of Chinese people's Liberation Army and the rehabilitation treatment center of Wangjing Hospital of Chinese Academy of traditional Chinese medicin from January 2015 to June 2019 were selected. The patients were divided into control group (n=56) and study group (n=56) according to odd and even numbers numbered according to admission sequence. The control group was given routine rehabilitation training combined with MI training, and the study group was combined with PNF trunk mode training on the basis of the control group. Both groups were intervened for 8 weeks. Carroll hand function assessment (UEFT), Fugl-Meyer motor function assessment (FMA), modified Barthel Index (mBI), functional walking classification (FAC), Tinetti gait assessment scale (TGA), trunk control ability test (TCT), Berg Balance Function Scale (BBS), sit-stand-sit time and torso forward tilt distance were compared before intervention, 4 weeks after intervention and 8 weeks after intervention. Results: The scores of UEFT, FMA and MBI of the two groups increased gradually at 4 weeks and 8 weeks after intervention, and study group was higher than control group (P<0.05). FAC and TGA scores of the two groups increased gradually at 4 weeks and 8 weeks after intervention, and the study group was higher than those control group (P<0.05). TCT and BBS scores of the two groups gradually increased at 4 weeks and 8 weeks after intervention, and study group was higher than control group (P<0.05). The sit-stand-sit time of the two groups gradually decreased at 4 weeks and 8 weeks after intervention, and study group was lower than control group (P<0.05), and the torso forward tilt distance was gradually increased, and study group was higher than control group (P<0.05). Conclusion: MI combined with PNF trunk mode training can effectively improve the walking function, upper limb function and trunk control ability of stroke patients with hemiplegia. [ABSTRACT FROM AUTHOR]

Objective: To observe the changes of walking function, quality of life and balance function of hemiplegic patients after treatment with intramuscular plaster combined with balance function training. Methods: From June 2018 to August 2020, 300 cases of stroke patients with hemiplegia who were admitted to our hospital were selected, and they were randomly divided into control group (150 cases, routine rehabilitation training and balance function training) and study group (150 cases, routine rehabilitation training, balance function training combined with intramuscular patch) according to the random number table method, all patients were treated for 4 weeks. The balance function, walking function, quality of life, pelocity of center of gravity swing and dynamic stabilization time when standing with eyes open, feet forward and back, and stand with eyes closed were compared. Results: 4 weeks after treatment, the scores of Fugl-Meyer lower limb motor function assessment (FMA) and Berg Balance Scale (BBS) in the two groups were higher than those before treatment, and the study group was higher than the control group(P<0.05). 4 weeks after treatment, the walking function indexes of the two groups: stride frequency, step width, stride speed, stride length were higher than those before treatment, and the study group was higher than the control group (P<0.05). 4 weeks after treatment, SF-36 score of each dimension in the two groups were higher than those before treatment, and the study group was higher than the control group (P<0.05). 4 weeks after treatment, the pelocity of center of gravity swing and dynamic stabilization time when standing with eyes open, feet forward and back, and stand with eyes closed in the two groups were lower than before treatment, and the study group was lower than the control group (P<0.05). Conclusion: Intramuscular plaster combined with balance function training in the treatment of stroke patients with hemiplegia can well recover the balance function of patients, improve the walking ability, and improve their quality of life. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to explore the efficacy of cerebellar intermittent theta burst stimulation (iTBS) on the walking function of stroke patients.Methods: Stroke patients with walking dysfunction aged 25–80 years who had suffered their first unilateral stroke were included. A total of 36 patients [mean (SD) age, 53 (7.93) years; 10 women (28%)] were enrolled in the study. All participants received the same conventional physical therapy, including transfer, balance, and ambulation training, during admission for 50 min per day during 2 weeks (10 sessions). Every session was preceded by 3 min procedure of cerebellar iTBS applyed over the contralesional cerebellum in the intervention group or by a similar sham iTBS in control group. The groups were formed randomly and the baseline characteristics showed no significant difference. The primary outcome measure was Fugl–Meyer Assessment–Lower Extremity scores. Secondary outcomes included walking performance and corticospinal excitability. Measures were performed before the intervention beginning (T0), after the first (T1) and the second (T2) weeks.Results: The Fugl–Meyer Assessment for lower extremity scores slightly improved with time in both groups with no significant difference between the groups and over the time. The walking performance significantly improved with time and between group. Two-way mixed measures ANOVA showed that there was significant interaction between time and group in comfortable walking time (F2,68 = 6.5242, P = 0.0080, η2partial = 0.276, ε = 0.641), between-group comparisons revealed significant differences at T1 (P = 0.0072) and T2 (P = 0.0133). The statistical analysis of maximum walking time showed that there was significant interaction between time and groups (F2,68 = 5.4354, P = 0.0115, η2partial = 0.198, ε = 0.734). Compared with T0, the differences of maximum walking time between the two groups at T1 (P = 0.0227) and T2 (P = 0.0127) were statistically significant. However, both the Timed up and go test and functional ambulation category scale did not yield significant differences between groups (P > 0.05).Conclusion: Our results revealed that applying iTBS over the contralesional cerebellum paired with physical therapy could improve walking performance in patients after stroke, implying that cerebellar iTBS intervention may be a noninvasive strategy to promote walking function in these patients. This study was registered at ChiCTR, number ChiCTR1900026450.

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Study Design: A systematic review and meta-analysis.Objective: This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury.Summary Of Background Data: Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial.Methods: Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software.Results: Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls.Conclusion: Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1. [ABSTRACT FROM AUTHOR]

Corticospinal tract (CST) is the major brain pathway yieldingmotor activity; however, functional role of the CST and other pathwaysin the implementation of such a socially important functionas walking in patients with stroke is not completely clear. Followingthe CST lesion the process of recovery involves not only CST onboth sides but also other pathways, including the extrapyramidaltracts: corticoreticular (CRP) and corticorubrospinal (CRSP)pathways. With the help of modern neurovisualization methods weshowed that Wallerian degeneration of the CST is not the only predictorof poor recovery of motor function after stroke, whereas acompensatory increase in fiber volume of CRP on the oppositeside may improve recovery of affected leg. Further studies of thefunctional significance of brain pathways including the CRP andCRSP in the recovery of post-stroke walking function will clarifyth mechanisms of neuroplasticity and predictors of recovery tooptimize the personalized approach to rehabilitation.

No recommended guidelines currently exist for the therapeutic concentration or dose of botulinum toxin type A (BTXA) injected into the muscle to treat limb spasticity. Therefore, in this randomized controlled trial, we explored the safety and efficacy of two concentrations and two doses of BTXA in the treatment of spastic foot after stroke to optimize this treatment in these patients. Eligible patients (n = 104) were randomized into four groups. The triceps surae and tibialis posterior on the affected side were injected with BTXA at one of two doses (200 U or 400 U) and two concentrations (50 U/mL or 100 U/mL). The following assessments were conducted before as well as 4 days and 1, 2, 4, and 12 weeks after treatment: spasticity, assessed using the modified Ashworth scale; basic functional mobility, assessed using a timed up and go test; pace, assessed using a 10-meter timed walking test; and the ability to walk, assessed using Holden's graded scale and a visual analog scale. The reported results are based on the 89 patients that completed the study. We found significant differences for the two doses and concentrations of BTXA to improve the ability of patients to walk independently, with the high-dose/low-concentration combination providing the best effect. Onset and duration of the ameliorating effects of BTXA were 4–7 days and 12 weeks, respectively. Thus, BTXA effectively treated foot spasms after stroke at an optimal dose of 400 U and concentration of 50 U/mL.

BACKGROUND: In clinical practice, MOTOmed lower limb function trainer combined with conventional rehabilitation training has been shown to be effective in the treatment of lower limb dysfunction after stroke, but it lacks evidence-based evidence. OBJECTIVE: To estimate the clinical efficacy of MOTOmed lower limb function trainer in the treatment of lower limb dysfunction in stroke patients with hemiplegia. METHODS: A computer-based online search of CBM, CNKI, Wanfang database, VIP Chinese Science and Technology Periodicals Database, Embase, Web of Science, PubMed, OVID, Cochrane Central Register of Controlled Trials, Cochrane Systematic Reviews for the randomized controlled studies of MOTOmed in the treatment of lower limb dysfunction in stroke patients with hemiplegia. Meta-analysis was performed using Revman5.3 software. RESULTS AND CONCLUSIONS: A total of 19 literatures were included, with a sample size of 1 099 cases. Patients in the experiment group received MOTOmed lower limb function exercise in combination with conventional rehabilitation treatment, and those in the control group only underwent conventional rehabilitation treatment. The results of meta-analysis showed that the Fugl-Meyer score of lower limb motor function in the experimental group was significantly higher than that in the control group [MD = 5.55, 95%C/ (4.08, 7.03), Z= 7.37, P < 0.01]. The Modified Ashworth Scale score in the experiment group was significantly lower than that in the control group [/WD=-0.13, 95%C/ (-1.37, -0.89), Z=9.19, P < 0.01]. The score of the 10-meter walking test in the experiment group was higher than that of the control group [MD= 10.15, 95%C/ (5.72, 14.58), Z=4.49, P < 0.01]. The Berg Balance scale score in the experiment group was significantly higher than that in the control group [A4D=13.66, 95%C/ (10.47, 16.85), Z=8.39, P < 0.01]. The functional ambulation category scale score in the experiment group was significantly higher than that in the control group [MD=0.85, 95%CI (0.68, 1.03), Z=9.48, P < 0.01]. The Modified Barthel Index in the experiment group was significantly higher than that in the control group [A4D=11.49, 95%C/ (8.96, 14.03), Z=8.89, P < 0.01], The results show that MOTOmed lower limb function trainer has a good clinical effect in the treatment of lower limb dysfunction in stroke patients with hemiplegia, but more high-quality clinical studies are needed to verify it. [ABSTRACT FROM AUTHOR]

Reduced daily stepping in stroke survivors may contribute to decreased functional capacity and increased mortality. We investigated the relationships between clinical and biomechanical walking measures that may contribute to changes in daily stepping activity following physical interventions provided to participants with subacute stroke. Following ≤40 rehabilitation sessions, 39 participants were categorized into three groups: responders/retainers increased daily stepping >500 steps/day post-training (POST) without decreases in stepping at 2–6 month follow-up (F/U); responders/non-retainers increased stepping at POST but declined >500 steps/day at F/U; and, non-responders did not change daily stepping from baseline testing (BSL). Gait kinematics and kinetics were evaluated during graded treadmill assessments at BSL and POST. Clinical measures of gait speed, timed walking distance, balance and balance confidence were measured at BSL, POST and F/U. Between-group comparisons and regression analyses were conducted to predict stepping activity from BSL and POST measurements. Baseline and changes in clinical measures of walking demonstrated selective associations with stepping, although kinematic measures appeared to better discriminate responders. Specific measures suggest greater paretic vs non-paretic kinematic changes in responders with training, although greater non-paretic changes predicted greater gains (i.e., smaller declines) in stepping in retainers at F/U. No kinetic variables were primary predictors of changes in stepping activity at POST or F/U. The combined findings indicate specific biomechanical assessments may help differentiate changes in daily stepping activity post-stroke. [ABSTRACT FROM AUTHOR]

To observe the effects of fuzhengbutu (strengthening antipathogenic qi and tonifying the earth) acupuncture–moxibustion therapy on walking function in the patients with post-stroke hemiplegia. A total of 57 patients with hemiplegia after ischemic stroke treated in our hospital from January 2018 through to October 2018 were collected as the study objects. According to random number table, they were divided into a treatment group (29 cases) and a control group (28 cases). In the treatment group, the fuzhengbutu acupuncture–moxibustion therapy combined with rehabilitation treatment was adopted. In the control group, the rehabilitation treatment was given. The persistent walking time and pause time in PIERENSTEP gait measurable training and test system as well as the score of Berg balance scale (BBS) were compared between the two groups. In the treatment group, the persistent walking time after treatment(1.47 ± 0.28) s was shorter obviously versus before treatment (2.12 ± 0.38) s, indicating the significant difference (P < 0.05). The pause time after treatment was not different obviously versus before treatment (P > 0.05). In the control group, the persistent walking time after treatment (1.88 ± 0.22) s was shorter obviously versus before treatment (2.18 ± 0.30) s, indicating the significant difference (P < 0.05). The pause time after treatment was not different obviously versus before treatment (P > 0.05). Before treatment, the differences were not significant in the persistent walking time and pause duration in the patients of either group (P > 0.05). After treatment, the persistent walking time in the treatment group was shorter obviously than the control group (P < 0.05) and the difference in pause time was not significant between the two groups (P > 0.05). Before treatment, there was no difference in BBS score between the two groups (P > 0.05). In the treatment group, BBS score (42.79 ± 2.78) after treatment was higher than (35.86 ± 2.64) before treatment, indicating the significant difference (P < 0.05). In the control group, BBS score (39.07 ± 2.67) after treatment was higher than (35.86 ± 2.64) before treatment, indicating the significant difference (P < 0.05). In comparison of BBS score after treatment between the two groups, the score in the treatment group was higher than the control group, indicating the significant difference (P < 0.05). Based on rehabilitation treatment, Fuzhengbutu acupuncture–moxibustion therapy effectively improves the walking function of the patients with hemiplegia after ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke., Methods: A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n  = 15) compared with the control group that received CR training only (CR group, n  = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking., Results: After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures ( p  < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT ( p  < 0.01), distance walked during the 6MWT ( p  < 0.05), and FMA-LE scores ( p  < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry ( p  < 0.001) after 10-session training, with no significant changes observed in the CR group., Conclusion: Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Xie, Zhang, Jin, Yang, Feng and Pan.)

Objectives: The purposes of the present study were to compare the effects of backward and lateral walking training and to identify whether additional backward or lateral walking training would be more effective in increasing the walking function of poststroke patients. Design: Fifty-one subjects with hemiplegic stroke were randomly allocated to 3 groups, each containing 17 subjects: the control group, the backward walking training group, and the lateral walking training group. The walking abilities of each group were assessed using a 10-m walk test and the GAITRite system for spatiotemporal gait. Results: The results show that there were significantly greater posttest increases in gait velocity (F = -12.09, P = 0.02) and stride length (F = -11.50, P = 0.02), decreases in the values of the 10-m walk test (F = -7.10, P = 0.03) (P < 0.05) and double-limb support period (F = 40.15, P = 0.000), and improvements in gait asymmetry (F = 13.88, P = 0.002) (P < 0.01) in subjects in the lateral walking training group compared with those in the other 2 groups. Conclusions: These findings demonstrate that asymmetric gait patterns in poststroke patients could be improved by receiving additional lateral walking training therapy rather than backward walking training. [ABSTRACT FROM AUTHOR]

Background: Accurate prediction of walking function after a traumatic spinal cord injury (SCI) is crucial for an appropriate tailoring and application of therapeutical interventions. Long-term outcome of ambulation is strongly related to residual muscle function acutely after injury and its recovery potential. The identification of the underlying determinants of ambulation, however, remains a challenging task in SCI, a neurological disorder presented with heterogeneous clinical manifestations and recovery trajectories., Objectives: Stratification of walking function and determination of its most relevant underlying muscle functions based on stratified homogeneous patient subgroups., Methods: Data from individuals with paraplegic SCI were used to develop a prediction-based stratification model, applying unbiased recursive partitioning conditional inference tree (URP-CTREE). The primary outcome was the 6-minute walk test at 6 months after injury. Standardized neurological assessments ≤15 days after injury were chosen as predictors. Resulting subgroups were incorporated into a subsequent node-specific analysis to attribute the role of individual lower extremity myotomes for the prognosis of walking function., Results: Using URP-CTREE, the study group of 361 SCI patients was divided into 8 homogeneous subgroups. The node specific analysis uncovered that proximal myotomes L2 and L3 were driving factors for the differentiation between walkers and non-walkers. Distal myotomes L4-S1 were revealed to be responsible for the prognostic distinction of indoor and outdoor walkers (with and without aids)., Conclusion: Stratification of a heterogeneous population with paraplegic SCI into more homogeneous subgroups, combined with the identification of underlying muscle functions prospectively determining the walking outcome, enable potential benefit for application in clinical trials and practice.

Objective: To analyze the correlation between balance function and gait parameters of patients with basal ganglia infarction. And to observe the influence of balance function on plantar pressure and hemiplegia gait based on the Berg Balance Scale (BBS) score., Methods: One hundred and forty patients with cerebral infarction hemiplegia in the basal ganglia region (a study group, n = 140) and healthy people (a control group, n = 140) were enrolled. The study group was evaluated with the BBS, the 10 m walking test (10MWT), and the timed up-and-go test (TUGT). The gait parameters and the peak plantar pressure were measured in both groups while walking, and the differences between the groups were compared. In addition, the characteristics of the plantar pressure curve of the hemiplegic and non-hemiplegic sides during walking and the correlation between the 10MWT, the TUGT, the plantar pressure peak, the gait parameters,and the BBS score were analyzed in the study group., Results: The peak plantar pressure of the forefoot and heel, stride length, lateral symmetry, stand phase, swing phase, and dual stand phase of both sides in the study group were significantly lower than those in the control group ( P < 0.05). The BBS score negatively correlated with the 10MWT, the TUGT, the peak plantar pressure of the hemiplegic forefoot, midfoot, and the non-hemiplegic midfoot, the anterior to posterior position (ant/post position), hemiplegic stand phase, and the dual stand phase ( P < 0.05). The BBS score positively correlated with the hemiplegic swing phase and stride length ( P < 0.05)., Conclusion: A correlation was found between the forefoot plantar pressure and the stand phase of the hemiplegic limbs, the ant/post position, and the balance function after basal ganglion cerebral infarction. This association can be used in walking and balance assessment for stroke rehabilitation. Correcting forefoot pressure or the front and ant/post position can improve balance function., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Liu, Yu, Wang and Dai.)

Background: Walking dysfunctions persist following poststroke rehabilitation. A major limitation of current rehabilitation efforts is the inability to identify modifiable deficits that, when improved, will result in the recovery of walking function. Previous studies have relied on cross-sectional analyses to identify deficits to target during walking rehabilitation; however, these studies did not account for the influence of a key covariate - maximum walking speed. Objective: To determine the relationships between commonly studied poststroke variables and the long-distance walking function of individuals poststroke when controlling for maximum walking speed. Methods: Correlation analyses of cross-sectional data from 57 individuals more than 6 months poststroke measured the relationships between standing balance, walking balance, balance self-efficacy, lower extremity motor function, and maximum walking speed versus long-distance walking function. For a subgroup of subjects who completed training, the relationship between changes in maximum walking speed versus changes in long-distance walking function was assessed. Results: Each measurement of interest strongly correlated with long-distance walking function (rs from 0.448 to 0.900, all Ps ≤ .001); however, when controlling for maximum walking speed, none of the other measurements remained related to long-distance walking function. In contrast, when controlling for each of the other measurements, maximum walking speed remained highly related. Moreover, changes in maximum walking speed resulting from training were highly related to changes in long-distance walking function (r = .737, P ≤ .001). Conclusions: For individuals in the chronic phase of stroke recovery, improving maximum walking speed may be necessary to improve long-distance walking function. [ABSTRACT FROM AUTHOR]