Physical Therapy Commons^™

The Effect Of Dual-Task Testing On Balance And Gait Performance In Adults With Type 1 Or Type 2 Diabetes Mellitus: A Systematic Review, Humberto Omana, Edward Madou, Manuel Montero-Odasso, Michael Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

BACKGROUND: Individuals with diabetes mellitus (DM) are susceptible to balance, gait and cognitive impairments. Importantly, diabetes affects executive function, a set of cognitive processes critical to everyday cortical function and mobility. Reduced executive function is a risk factor for falls in people with DM. Dual-task testing, the completion of two tasks at once, enables the examination of the cognitive-mobility relationship. A synthesis of the literature on the effects of dual- task testing on the balance and gait of individuals with DM has not been performed.

OBJECTIVE: To systematically review the literature on the effect of dual-task testing on balance and …

Cognitive-Motor Interactions In Gait And Postural Control And Cortical Network Neurocorrelates, Nathan Morelli

Theses and Dissertations--Rehabilitation Sciences

The ability to mitigate performance decrements during the concurrent completion of cognitive and motor tasks (i.e., dual task (DT)) deteriorates in patients with mild Traumatic Brain Injury (mTBI). It is theorized that the long-term sequelae of mTBI are due to the return to full activity prior to neurophysiologic healing. To mitigate the negative outcomes associated with mTBIs, translational clinical research of neurophysiologic recovery is of paramount importance for both athletic and non-athletic populations. Despite the well-known health consequences, clinical decisions regarding neurophysiologic recovery and return to activity remain problematic for clinicians. Return to activity decisions are currently based on normalization …

Neuromuscular Response To A Single Session Of Whole-Body Vibration In Children With Cerebral Palsy: A Pilot Study, Huaqing (Virginia) Liang, Gena Henderson, Jianhua Wu

Physical Therapy Faculty Research

Background Whole-body vibration (WBV) is a relative new intervention paradigm that could reduce spasticity and improve motor function in children with cerebral palsy (CP). We investigated neuromuscular response to a single session of side-alternating WBV with different amplitudes in children with CP.

Methods Ten children with spastic CP aged 7–17 years at GMFCS level I-III participated in this pilot study. Participants received two sessions of side-alternating WBV with the same frequency (20 Hz) but different amplitudes (low-amplitude: 1 mm and high-amplitude: 2 mm). Each session included six sets of 90 s of WBV and 90 s of rest. Before and …

Validation Of An Inertial-Measurement-Unit System For Calculating Hip And Knee Flexion Angles During Gait, Joonsun Park

Master's Theses

Technological advances regarding Inertial Measurements Units (IMUs) have positioned this type of sensor as an alternative for camera-based motion capture. This study introduces a new IMU based system (IMU_sys) to measure hip and knee flexion angles. PURPOSE: To validate the use of a five-sensor IMU_sys for the measurement of knee and hip flexion angles during gait in adults and pediatrics at two different time points. METHODS: Bilateral hip and knee flexion patterns (LH, RH, LK, and RK) of twenty-two healthy participants (12 adults and 10 pediatric) between the ages of 8 – 35 years were investigated. Participants …

Effects Of Visual Referencing On Backward And Forward Treadmill Walking In Vr Environments, Rahul Soangra, Sivakumar Rajagopal

Physical Therapy Faculty Articles and Research

Backward walking is used increasingly as a rehabilitation exercise for stroke and diabetic peripheral neuropathy patients to improve strength and balance. However, it is unclear how visual referencing affects backward and forward walking. In this study, we evaluated spatiotemporal gait characteristics changes due to visual referencing while backward/forward walking. Sixteen healthy young participants were recruited in this study. All participants walked for 2 min with and without visual referencing in the virtual reality environment. While walking backward participants faced the virtual reality screen similar to forward walking, but their treadmill belt direction of movement was reversed. All participants walked at …

A Consensus Guide To Using Functional Near-Infrared Spectroscopy In Posture And Gait Research, Jasmine C. Menant, Inbal Maidan, Lisa Alcock, Emad Al-Yahya, Antonio Cerasa, David J. Clark, Eling D. De Bruin, Sarah Fraser, Vera Gramigna, Dennis Hamacher, Fabian Herold, Roee Holtzer, Meltem Izzetoglu, Shannon Lim, Annette Pantall, Paulo Pelicioni, Sue Peters, Andrea L. Rosso, Rebecca St George, Samuel Stuart, Roberta Vasta, Rodrigo Vitorio, Anat Mirelman

Physical Therapy Publications

Background: Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works.

Research question and methods: Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders.

Results: Our paper is organized around three main sections: …

Post-Stroke Cognitive Impairments And Responsiveness To Motor Rehabilitation: A Review, Jennapher Lingo Vangilder, Andrew Hooyman, Daniel S. Peterson, Sydney Y. Schaefer

Physical Therapy Faculty Articles and Research

Purpose of Review
This review discusses the prevalence of cognitive deficits following stroke and their impact on responsiveness to therapeutic intervention within a motor learning context.

Recent Findings
Clinical and experimental studies have established that post-stroke cognitive and motor deficits may impede ambulation, augment fall risk, and influence the efficacy of interventions. Recent research suggests the presence of cognitive deficits may play a larger role in motor recovery than previously understood.

Summary
Considering that cognitive impairments affect motor relearning, post-stroke motor rehabilitation therapies may benefit from formal neuropsychological testing. For example, early work suggests that in neurotypical adults, cognitive function …

The Association Between Medication Use And Gait In Adults With Intellectual Disabilities, S. Maas, D. A.M. Festen, Thessa I.M. Hilgenkamp, A. Oppewal

Physical Therapy Faculty Research

Background: Adults with intellectual disabilities (ID) often have polypharmacy and often use antipsychotics. Both polypharmacy and antipsychotics have a negative effect on gait in the general population, but this has not been studied in adults with ID. These negative effects may add to pre‐existing gait disturbances in adults with ID and increase the risk for adverse health outcomes in this population. Therefore, the aim of this study is to investigate the difference in gait parameters between adults with ID with and without polypharmacy and between adults with ID using and not using antipsychotics. Method: The gait parameters of 31 participants …

Effect Of Motor-Assisted Elliptical Training Speed And Body Weight Support On Center Of Pressure Movement Variability, Farahnaz Fallahtafti, Chase M. Pfeifer, Thad W. Buster, Judith M. Burnfield

Department of Mechanical and Materials Engineering: Faculty Publications

Background: A motor-assisted elliptical trainer is being used clinically to help individuals with physical disabilities regain and/or retain walking ability and cardiorespiratory fitness. Unknown is how the device’s training parameters can be used to optimize movement variability and regularity. This study examined the effect of motor-assisted elliptical training speed as well as body weight support (BWS) on center of pressure (CoP) movement variability and regularity during training. Methods: CoP was recorded using in-shoe pressure insoles as participants motor-assisted elliptical trained at three speeds (20, 40, and 60 cycles per minute) each performed at four BWS levels (0%, 20%, 40%, and …

Passive, Yet Not Inactive: Robotic Exoskeleton Walking Increases Cortical Activation Dependent On Task, Sue Peters, Shannon B. Lim, Dennis R. Louie, Chieh-Ling Yang, Janice J. Eng

Physical Therapy Publications

Background

Experimental designs using surrogate gait-like movements, such as in functional magnetic resonance imaging (MRI), cannot fully capture the cortical activation associated with overground gait. Overground gait in a robotic exoskeleton may be an ideal tool to generate controlled sensorimotor stimulation of gait conditions like ‘active’ (i.e. user moves with the device) and ‘passive’ (i.e. user is moved by the device) gait. To truly understand these neural mechanisms, functional near-infrared spectroscopy (fNIRS) would yield greater ecological validity. Thus, the aim of this experiment was to use fNIRS to delineate brain activation differences between ‘Active’ and ‘Passive’ overground gait …

Mediolateral Damping Of An Overhead Body Weight Support System Assists Stability During Treadmill Walking, M. Bannwart, S. L. Bayer, Niklas König Ignasiak, M. Bolliger, G. Rauter, C. A. Easthope

Physical Therapy Faculty Articles and Research

Background

Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along …

Reliable And Valid Measures For The Clinical Assessment Of Balance And Gait In Older Adults With Dementia: A Systematic Review, Jacqueline Baker, Danielle De Laat, Emily Kruger, Sarah Mcrae, Sabrina Trung, Carly Zottola, Humberto Omana, Susan W. Hunter

Physical Therapy Publications

No abstract provided.

Association Between Changes In Subjective And Objective Measures Of Mobility In People With Lower Limb Amputations After Inpatient Rehabilitation, Gabrielle Cieslak, Humberto Omana, Edward Madou, Courtney Frengopoulos, Ricardo Viana, Michael W Payne, Susan W. Hunter

Physical Therapy Publications

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Assessment times: discharge and 4-mo follow-up. Gait velocity and the L Test under single- and dual-task conditions measured objective mobility. The Prosthetic Evaluation Questionnaire (section 4 and question 5b) measured subjective mobility. Paired t tests and Pearson correlation analysis evaluated change over time …

The Effects Of Somatosensory Input On Gait In Individuals Post-Stroke, Victor Hung, Amanda Reilly, Rachel Wood, Nikita Yuskov

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Stroke is a leading cause of disability that results in various neurological deficits, one of which is hemiplegia. This deficit alters the gait cycle, resulting in decreased propulsion force by plantar flexor muscles, decreased activation of dorsiflexor (DF) muscles, and increased coactivation of antagonistic ankle muscles. Stroke also leads to altered somatosensory input which results in decreased balance and gait speed, ultimately increasing fall risk. Therapies targeting increased somatosensory input have been shown to be beneficial in stroke as well as other neurological populations. However, no known studies have investigated the acute effects of local vibration to …

Effect Of Dual-Tasking On Walking And Cognitive Demands In Adults With Alzheimer's Dementia Experienced In Using A 4-Wheeled Walker, Susan W. Hunter, Humberto Omana, Edward Madou, Walter Wittich, Keith D Hill, Andrew M Johnson, Alison Divine, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations.

RESEARCH QUESTION: What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker?

METHODS: Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience …

Improvement In Overground Walking After Treadmill-Based Gait Training In A Child With Agenesis Of The Corpus Callosum, Gena Henderson, Matthew Beerse, Huaqing Liang, Diego Ferreira, Jianhua Wu

Physical Therapy Faculty Research

Background: Agenesis of the corpus callosum (ACC) is a rare congenital brain defect that produces a wide variety of cognitive and motor impairments. Literature regarding the response of pediatric populations with ACC to physical rehabilitation is scarce. Treadmill-based gait training (TT) has been shown to improve walking ability in some pediatric populations but has not been investigated in children with ACC.

Objective: The purpose of this study was to investigate the effect of a novel treadmill intervention paradigm on the gait parameters of a child with ACC.

Design: A single-participant design with 2 phases was used.

Methods: The settings were …

Knee Joint Loading Following Anterior Cruciate Ligament Reconstruction: Link To Patient Reported Outcomes And A Novel Method To Monitor With Wearable Sensors, Alex Spencer

Theses and Dissertations--Kinesiology and Health Promotion

Recovery from anterior cruciate ligament reconstruction (ACLR) commonly results in undesirable physical and patient-reported outcomes (PROs). Identification of modifiable factors such as knee contact force (KCF) early in rehabilitation that can improve these outcomes is important due to the rapid decrease in function, quality of life, and joint health in this population. Additionally, if noninvasive measurement of KCFs outside of a traditional laboratory were possible, clinicians could optimize patient treatment with personalized care. Therefore, there are two primary aims to this thesis: 1) quantify the link between KCF and PROs which measure pain, ability to perform activities of daily living, …

Rehabilitation Modifications For A Patient With Parkinson’S Disease Following A Suspected Case Of Gilbert’S Syndrome: A Case Study, Jason Bandong, Hy Ia, Naureen Imam, Kayla Wilcox, Travis Dennis

San Marcos, Summer 2019

The purpose of this case study was to assess the effects of core stabilization exercises, balance training, agility ladder step drills, fine motor, and dual-task training in the treatment of a high-functioning, 55-year-old, male patient with a history of Parkinson’s Disease and suspected Gilbert’s Syndrome.

This treatment program delivered for 1 hour once per week over 4 weeks led to mild improvements in activity limitations with the most notable being able to button a shirt with decreased time and assistance. The patient also exhibited mild improvement in body structure/function impairments with decreased loss of balance as evident during tandem walking …

Effect Of Learning To Use A Mobility Aid On Gait And Cognitive Demands In People With Mild To Moderate Alzheimer's Disease: Part I - Cane, Susan W. Hunter, Alison Divine, Humberto Omana, Walter Wittich, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: People with Alzheimer's disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD.

OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking.

METHODS: Seventeen participants with AD (age …

The Effect Of A Novel Rehabilitation Program On Walking Performance In Persons With Multiple Sclerosis, Alyssa J. Rebensburg

All NMU Master's Theses

The purpose of this study was to compare if the addition of the NewGait™ device to traditional therapy in comparison to traditional therapy alone would be more effective at improving walking technique and walking performance in persons with multiple sclerosis. Eighteen patients with multiple sclerosis participated in this study. Pre- and post-testing assessed kinematic gait variables (speed, step length, step width, double limb support time), toe clearance height, ankle range of motion, balance confidence, rating of perceived exertion, and hip-ankle coordination. Participants completed an 8-week physical therapy protocol aimed to improve gait and balance with the experimental group wearing the …

Variability Of Spatiotemporal Gait Parameters In Children With And Without Down Syndrome During Treadmill Walking, Matthew Beerse, Gena Henderson, Huaqing Liang, Toyin Ajisafe, Jianhua Wu

Physical Therapy Faculty Research

Methods: Thirteen children with DS (aged 7–10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS.

Results and significance: Across all conditions, the DS group took shorter and wider steps than the TD group, but …

Effect Of Learning To Use A Mobility Aid On Gait And Cognitive Demands In People With Mild To Moderate Alzheimer's Disease: Part Ii - 4-Wheeled Walker., Susan W. Hunter, Alison Divine, Humberto Omana, Walter Wittich, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk.

OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults.

METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight …

Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz

Physical Therapy Scholarly Projects

Background/Purpose: The Four Square Step Test (FSST) measures dynamic standing balance and agility and was developed to identify older adults at risk for falls. It has a cognitive component for remembering the stepping sequence but has never been tested with an additional cognitive task. The purpose of this study was to collect normative data for the FSST and Cognitive FSST in community dwelling adults for various age groups.

Materials/Methods: Eighty-seven community-dwelling adults (55 females, 32 males) between the age 21 and 86 (48.22 years) were included in the study. Participants completed a fall risk checklist and a cognitive screen prior …

Trunk Control And Gross Motor Outcomes After Body-Weight Supported Treadmill Training In Young Children With Severe Cerebral Palsy: A Case Series, Megan Flores, Carolyn Da Silva

Physical Therapy Collection

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V present with decreased gross motor function and trunk control that impacts their functional activities and participation in family activities. Research indicates body-weight supported treadmill training (BWSTT) may improve motor control for children with neuromotor disabilities. The toddler years present a window of opportunity for developmental changes. The purpose of this case series was to explore the impact of a 6-week BWSTT intervention on postural control and gross motor function in 3 young children with cerebral palsy in GMFCS levels IV and …

Trunk Control And Gross Motor Outcomes After Body Weight Supported Treadmill Training In Young Children With Severe Cerebral Palsy: A Non-Experimental Case Series, Megan Flores, Carolyn P Da Silva

Physical Therapy Collection

OBJECTIVE: To explore the impact of a body weight supported treadmill training (BWSTT) intervention on postural control and gross motor function in three young children with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels IV or V.

METHOD: Children (N = 3) between the ages of 2-3 years who were diagnosed with CP classified as GMFCS levels IV and V participated in BWSTT three times per week. The Segmental Assessment of Trunk Control (SATCo) and the gross motor function measure (GMFM-66) were assessed before and after the 6-week intervention.

RESULTS: Final testing revealed …

Power Up With Parkinson's: A Case Report, Sean Ekekwe, Anne H. Boddy

St. Augustine, Fall 2018

The purpose of this study is to highlight the use of power training in a patient with low back pain and Parkinson’s disease.

Power training demonstrated a more significant change in gait speed, mobility, and function compared to other phases in rehabilitation. After power training was implemented at visit 11, there was a dramatic increase gait speed with the 10-meter walk test, a reduction in Oswestry Disability Index score (ODI), and a decrease in Timed Up and Go (TUG) time. The increase in 10 MWT gait speed and reduction in ODI and TUG score were greater than their MDC values …

External Load On The Hemi-Paretic Lower Limb With Task-Oriented Training To Improve Gait Post Right Aca Stroke, Jacob France, Lindsey Perry

St. Augustine, Fall 2018

The purpose of this case report is to describe the treatment of a 77-year-old male post-stroke with the application of an external load to the paretic lower limb in conjunction with task-oriented training to improve gait.

Strength, balance, gait speed, and functional tasks all improved over the course of physical therapy. At the end of 2 weeks, the patient exceeded the minimal detectable change (MDC) for the TUG (2.9 sec) and achieved the minimal clinically important difference (MCID) for the FIM (22 points).^4-5 Although the MCID is not established for the Modified Ashworth Scale (MAS), the patient experienced improvements …

Sara Plus And Task Specific Training In A Patient With Anoxic Encephalopathy, Olivia Levi, Erica Kiernan

St. Augustine, Fall 2018

The purpose of this case report is to describe the benefits of using a task-specific approach and the SARA plus to improve balance and gait in a patient with anoxic encephalopathy.

This case demonstrated the positive results of incorporating repetitive, task-specific, and early use of the SARA plus for gait training. With these interventions, the patient was able to ambulate 25 ft and transfer from sit to stand with the use of a rolling walker and minimum assistance. He was also able to maintain static sitting balance for 32 seconds independently and reach 17 inches outside of his base of …

Effects Of Weight Shifting And Heel Lift On Gait, Posture, And Balance In An Elderly Female With Backward Disequilibrium: A Case Report, Gilissa T. Schjang, Evan M. Pucillo

St. Augustine, Fall 2018

The purpose of this case report is to investigate how weight shifts and a heel lift affects a patient's center of mass in respect to their base of support to improve posture, balance, and gait which will aid in decreasing falls.

The patient demonstrated functional improvements by reducing the amount of assistance required from a caregiver for transfers and gait. Improvements in balance will allow the patient to sit on the toilet and edge of bed for toileting and dressing more independently.

Older adults with BD or other similar balance disorders are at risk for increased falls.⁵ This case …

A Framework For Secondary Cognitive And Motor Tasks In Dual-Task Gait Testing In People With Mild Cognitive Impairment., Susan W Hunter, Alison Divine, Courtney Frengopoulos, Manuel Montero Odasso

Physical Therapy Publications

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).

METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined …