Haidzir Manaf

Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review

Purpose. The aim of this paper is to review the published studies on the characteristics of impairments in the postural control and gait performance in diabetic peripheral neuropathy (DPN). Methods. A review was performed by obtaining publication of all papers reporting on the postural control and gait performance in DPN from Google Scholar, Ovid, SAGE, Springerlink, Science Direct (SD), EBSCO Discovery Service, and Web of Science databases. The keywords used for searching were “postural control,” “balance,” “gait performance,” “diabetes mellitus,” and “diabetic peripheral neuropathy.” Results. Total of 4,337 studies were hit in the search. 1,524 studies were screened on their titles and citations. Then, 79 studies were screened on their abstract. Only 38 studies were eligible to be selected: 17 studies on postural control and 21 studies on the gait performance. Most previous researches were found to have strong evidence of postural control impairments and noticeable gait deficits in DPN. Deterioration of somatosensory, visual, and vestibular systems with the pathologic condition of diabetes on cognitive impairment causes further instability of postural and gait performance in DPN. Conclusions. Postural instability and gait imbalance in DPN may contribute to high risk of fall incidence, especially in the geriatric population. Thus, further works are crucial to highlight this fact in the hospital based and community adults.

Functional balance and motor impairment correlations with gait parameters during timed up and go test across three attentional loading conditions in stroke survivors

The aim of this study was to determine whether stroke survivors gait performance during dual-task Timed Up and Go (TUG) test is correlated with the level of functional balance and motor impairment. Thirty stroke survivors (22 men, 8 women) were recruited for this study. The level of functional balance (Berg Balance Scale) and motor impairment (Fugl-Meyer assessment lower extremity) were assessed prior to the TUG test. TUG test was conducted under three attentional loading conditions (single, dual motor, and dual-cognitive). The time and number of steps were used to quantify gait parameters. The Spearmens rank correlation coefficient was used to evaluate the relationship between these variables. There was moderate to strong negative correlation between functional balance and gait parameters (range −0.53 to −0.73, P < 0.05). There was a weak negative correlation observed between the time taken to complete the single task and motor impairment (r s = −0.43; P = 0.02) dual motor task and motor impairment (r s = −0.41; P = 0.02). However, there were no significant correlations between lower limb motor impairment and the number of steps in all conditions. These findings suggest that functional balance may be an influential domain of successful dual-task TUG in stroke.

Turning Ability in Stroke Survivors: A Review of Literature

The aim of this paper is to explore the research literature on the turning ability among stroke survivors. Stroke is one of the top five leading causes of death and disability in Malaysia. Stroke survivors reported a higher rate of fall incidences with turning while walking has been the major contributor in most of the incidences. The attentional task requires stroke survivors to have higher cognitive and attention function, and sound muscle coordination in order to perform multitask activities such as driving, walking and turning while talking, carrying an object (holding a plastic bag), navigating corners and overcoming obstacles within the base of support. Most of the previous studies have focused on the kinematic and gait parameters measurement of turning ability among stroke survivors. However, studies conducted on muscle activity using electromyography to evaluate the time pattern of muscle contraction during turning event is lacking. With regards to dual-task ability among stroke survivors, there is insufficient information or research into dual task (motor and cognitive) ability during turning. Further studies are needed to understand the effects of dual-task activity on muscle activity and gait parameters and how this impairment affects the turning ability. This needs to be addressed in order to prevent falls among stroke survivors.

Comparison of gait parameters across three attentional loading conditions during timed up and go test in stroke survivors

Abstract Background: Little is known about the effects of attentional loading on performance of turning during walking in individuals with stroke. Objective: The authors used a cross-sectional experimental design to compare gait parameters in stroke survivors across 3 attentional loading conditions (single, dual-motor, and dual-cognitive conditions) during a Timed Up and Go (TUG) test. Methods: Data were collected from 20 stroke survivors (12 males, 8 females; mean age, 60.5 ± 10.6 years). We compared the number of steps and time measured during the TUG test under 3 attentional loading conditions and 2 turning directions (nonparetic and paretic sides). We further divided the TUG test into straight walking and turning phases. Results: The number of steps and the time taken during TUG test increased significantly from single- to dual-task conditions (dual motor and dual cognitive). However, there were no significant differences in gait parameters between turning toward the nonparetic and paretic sides. Conclusions: These findings suggested that gait performance was compromised during dual-task conditions for individuals with stroke. Attentional loading may be incorporated into routine gait assessment and rehabilitation to ensure a successful recovery.

Sharp Turning and Corner Turning: Comparison of Energy Expenditure, Gait Parameters, and Level of Fatigue among Community-Dwelling Elderly

This study compares energy expenditure (EE), gait parameters (GP), and level of fatigue (LOF) between 5-minute walking with sharp turning (ST) and corner turning (CT). Data were obtained from 29 community-dwelling elderly (mean age, 62.7 ± 3.54 years). For 5 minutes, in ST task, participants walked on a 3-meter pathway with 2 cones placed at each end (180° turning), while in CT task, participants walked on a 6-meter pathway with 4 cones placed at 4 corners (90° turning). The physiological cost index, pedometer, and 10-point Modified Borg Dyspnoea Scale were used to measure EE (beats/min), GP (no of steps), and LOF, respectively. Data were analyzed by using independent t-tests. EE during ST (0.62 ± 0.21 beats/min) was significantly higher than CT (0.48 ± 0.17 beats/min) (P < 0.05). GP (434 ± 92.93 steps) and LOF (1.40 ± 1.11) in ST were found to be lower compared to GP (463 ± 92.18 steps) and LOF (1.54 ± 1.34) in CT (All, P > 0.05). Higher EE in ST could be due to the difficulty in changing to a 180° direction, which may involve agility and different turning strategies (step-turn or pivot-turn) to adjust the posture carefully. In CT, participants could choose a step-turn strategy to change to a 90° direction, which was less challenging to postural control.

Effects of Attentional Loadings on Gait Performance Before Turning in Stroke Survivors

Attentional loadings have significant impacts on turning performance in individuals with stroke. Improper gait modification before turning may contribute to falls after stroke. Therefore, examination of the changes in temporal‐spatial gait parameters before turning may reveal important deficits in gait control when stroke survivors are challenged by dual‐tasking.

Axial Segmental Coordination During Turning: Effects of Stroke and Attentional Loadings

Attentional loadings deteriorate straight walking performance for individuals poststroke, but its effects on turning while walking remain to be determined. Here we compared turning kinematics under three attentional loading conditions (single, dual-motor, and dual-cognitive task) between stroke survivors and healthy controls. Nine chronic stroke survivors and 10 healthy controls performed the Timed Upand- Go test while their full-body kinematics were recorded. Onset times of yaw rotation of the head, thorax and pelvis segments and head anticipation distance were used to quantify turning coordination. Results showed that stroke survivors reoriented their body segments much earlier than the controls, but they preserved the similar segmental reorientation sequence under the single-task condition. For the healthy controls, attentional loading led to an earlier axial segment reorientation, but the reorientation sequence was preserved. In contrast, the dual-cognitive task condition led to a disrupted reorientation sequence in stroke. The results indicate that turning coordination was altered in individuals poststroke, especially under the dual-task interference.

Mobility and Balance and Their Correlation with Physiological Factors in Elderly with Different Foot Postures

This study determines (1) the correlation between mobility and balance performances with physiological factors and (2) the relationship between foot postures with anthropometric characteristics and lower limb characteristics among elderly with neutral, pronated, and supinated foot. A cross-sectional observational study was conducted in community-dwelling elderly (age: 69.86 ± 5.62 years). Participants were grouped into neutral (n = 16), pronated (n = 14), and supinated (n = 14) foot based on the foot posture index classification. Anthropometric data (height, weight, and BMI), lower limb strength (5-STS) and endurance (30 s chair rise test), mobility (TUG), and balance (FSST) were determined. Data were analyzed using Spearmans correlation coefficient. Body weight was negatively and moderately correlated (r s = −0.552, P < 0.05) with mobility in supinated foot; moderate-to-high positive linear rank correlation was found between lower limb strength and mobility (r s = 0.551 to 0.804, P < 0.05) for pronated and neutral foot. Lower limb endurance was negatively and linearly correlated with mobility in pronated (r s = −0.699) and neutral (r s = −0.573) foot. No correlation was observed in balance performance with physiological factors in any of the foot postures. We can conclude that muscle function may be the most important feature to make movement possible in older persons regardless of the type of foot postures.

Range of motion, muscle length, and balance performance in older adults with normal, pronated, and supinated feet

[Purpose] To compare the lower limb joint range of motion and muscle length between different types of foot posture, and determine the correlation of range of motion and muscle length with balance performance. [Subjects and Methods] Ninety individuals (age, 65.2±4.6 years) were assessed using the Foot Posture Index to determine their type of foot (Normal [0 to +5], pronated [+6 to +9], and supinated [−1 to −4]; n=30 per group). The range of motion (goniometer), muscle length (goniometer and tape measure), and balance performance (functional reach test and four square step test) were measured for each participant. Data were analyzed using the Kruskal-Wallis test and Spearman’s rank-order correlation. [Results] No significant differences were found in range of motion, muscle length, and balance performance among different types of foot posture, except for right and left ankle dorsiflexion range of motion. Balance performance was significantly correlated with selected muscle length and range of motion, especially in the supinated foot. [Conclusion] Range of motion and muscle length of the lower limb may be associated with balance performance in older adults with foot deformities. These findings may guide physiotherapists in choosing intervention based on specific assessments for older adults with foot deformity.

Analysis of kinematic gait parameters in chronic stroke survivors

This paper presents the gait pattern classification between stroke survivors and normal subjects. This present investigation is competent to reveal the characteristics of postural control, gait pattern among stroke survivors. These findings also are capable in giving the effective guidelines for developing appropriate strategies for safe standing and walking to reduce fall incidence. Furthermore, this results also can be used to monitor stroke patients, in the aspects of theirs rehabilitation progress from time to time. 18 subjects has been recruited (nine stroke subjects and nine normal subjects) with range of age between 40 to 65 years old. Additionally, all subjects must be able to walk freely without any cane or mechanical aid during walking. In this study, Vicon® Nexus Plug-in-Gait is used to compute the kinematic gait parameters. Movements in anatomical planes is used as a reference during walking. This paper focus on the sagittal plane only. From the results, it is found that there is a significant difference in the maximum angle of knee between stroke and normal subjects. As a conclusion, the significant value which is 0.003 only can be observed from the maximum knee angle between both groups. The results of this study may be varies due to several aspects such as physical body structure and also age.