Lugkana Mato

Discriminative ability of the three functional tests in independent ambulatory patients with spinal cord injury who walked with and without ambulatory assistive devices

Abstract Background/objectives Many persons with spinal cord injury (SCI) require an ambulatory assistive device (AAD). An effective monitoring method enables the use of an appropriate AAD and promotes levels of independence for patients. This study investigated the discriminative ability of the three-functional tools relating to walking ability, including the 10-meter walk test (10MWT), the five times sit-to-stand test (FTSST), and the timed up and go test (TUGT), in independent ambulatory persons with SCI who walked with walker, crutches, cane, and non-AAD. Methods Eighty-five persons with SCI who could perform sit-to-stand and walk independently at least 50 m were cross-sectionally assessed for their functional ability using the 10MWT, FTSST, and TUGT. Results The findings for persons not using AADs were significantly better than the other groups for every test (P < 0.001). In addition, persons who walked with cane were significantly different from those who used walkers (P < 0.001) but there were no significant differences between persons who used walker and crutches for every test (P > 0.05). Conclusion The findings supported the discriminative validity of the tools, allowing them to indicate functional changes in persons with SCI who walk with different AADs. However, the non-significant differences between subjects who used a walker and crutches may relate to the method of subject arrangement and inclusion criteria that recruit subjects with rather good walking capability and lower limb function. The findings may also suggest the use of the sit-to-stand maneuver as a simple screening tool for walking advancement of walker users, pending further investigation.

Ambulatory assistive devices and walking performance in patients with incomplete spinal cord injury

Study design:A cross-sectional study.Objectives:To primarily explore types of ambulatory assistive device (AAD) used and secondarily describe walking performance in independent ambulatory patients with spinal cord injury (SCI) who walked without and with various AADs as determined using walking speed and distance walked in 6 min.Setting:A tertiary rehabilitation center and community hospitals, Thailand.Methods:The data of 195 independent ambulatory patients with SCI were used to describe the use of an AAD. Among these, only 140 subjects were assessed for their walking speed and distance walked in 6 min.Results:More than half of the subjects (64%) walked with an AAD in which most of them used a standard walker (45%), followed by a single-tip cane (11%) and bilateral crutches (8%), respectively. The walking speed and distance showed significant differences among the groups (P<0.001), except those who used walker versus crutches, and those who used crutches versus cane (P>0.05). Among the significant variables, types of AAD used had the greatest influence on walking speed and distance of the subjects.Conclusion:More than half of ambulatory subjects with SCI walked with an AAD in which most of them used a standard walker. However, the non-significant differences of walking performance between the groups may suggest the heterogeneity of walking ability in subjects who used the same type of AAD. Therefore, a method to facilitate the use of an AAD with less supportive ability would increase levels of independence for the patients.

Functional ability and health status of community-dwelling late age elderly people with and without a history of falls

Background: Obvious functional deterioration is demonstrated in elderly people aged 75 years and older. However, there is only little objective evidence relating to falls in these individuals. Objective: This cross-sectional study compared functional abilities and health status in the elderly age at least 75 years with no fall, single fall (1 fall), and multiple falls (≥2 falls) during the past 6 months. Furthermore, the study describes fall information of the participants. Methods: Ninety participants (30 individuals/group) were interviewed for their health status and fall history within the past 6 months. Then they were objectively assessed in terms of their functional ability to conduct daily activities independently. Results: The findings indicated that the functional abilities of participants with multiple falls were significantly poorer, with the number of those requiring a walking device significantly greater than that in the other groups. These individuals reported loss of balance as a major factor for falls, whereas individuals with a single fall reported an environmental hazard as a common cause of falls. Conclusion: Although the cross-sectional findings may be unable to clearly confirm the causal relationship of the outcomes, the data support the influence of intrinsic impairments and can be used to promote functional ability and minimise fall risk in these individuals.

Ability of sit-to-stand with hands reflects neurological and functional impairments in ambulatory individuals with spinal cord injury

Study designA cross-sectional study.ObjectivesTo explore the need of upper limb contribution during sit-to-stand (STS) in ambulatory participants with spinal cord injury (SCI) and compare the lower limb loading during the sit-to-stand (LLL-STS) in those with SCI who performed the task with or without hands as compared to able-bodied individuals. In addition, the study assessed the correlation between the LLL-STS, and sensorimotor scores and functional ability in ambulatory participants with SCI.SettingA tertiary rehabilitation center and community hospitals, Thailand.MethodsForty-three participants with SCI who could perform STS with or without hands, and 10 able-bodied individuals were interviewed and assessed for their demographics, STS, and LLL-STS ability. Moreover, participants with SCI were assessed for SCI characteristics, sensorimotor scores, and functional ability relating to independent walking.ResultsMore than half of participants with SCI (58%) performed STS using hands. Their LLL-STS, sensorimotor, and functional ability were significantly lower than those with SCI who performed the task without hands. The LLL-STS of participants with SCI, particularly amount, was significantly associated with their sensorimotor scores and functional ability (P < 0.05).ConclusionsThe findings indicated that those with marked lower limb muscle weakness and sensory impairments used their hands during STS. As such, the use of the hands during STS can be used as an indicator of neurological and functional impairments in ambulatory individuals with SCI.

Failures in dual-task obstacle crossing could predict risk of future fall in independent ambulatory individuals with spinal cord injury

Objective: To determine whether cognitive-motor interference using ability of dual-task obstacle crossing could predict a risk of fall in 90 ambulatory individuals with spinal cord injury. Design: Six-month prospective study. Setting: A rehabilitation center and community hospitals. Subjects: Independent ambulatory individuals with spinal cord injury. Main outcome measures: Subjects were interviewed and evaluated for personal characteristics, dual-task obstacle crossing ability, and functional ability using the 10 Meter Walk Test, Timed Up and Go Test, and Five Times Sit-to-Stand Test. Then they were prospectively monitored for fall data every month for six months in total. Results: A total of 90 chronic ambulatory individuals with spinal cord injury with an average age of 52.51 ± 13.43 years, who mostly had mild lesion severity (n = 71, 79%) and walked with a walking device (n = 54, 60%) completed in the study. More than one-third of the subjects (n = 32, 36%) failed in dual-task obstacle crossing. The failures were obviously associated with the fall (unadjusted odds ratio = 7.07, P < 0.002, power = 1.000). Conclusion: Cognitive-motor interference is important for ambulatory individuals with spinal cord injury, as it could detect those with low functional ability and risk of future falls.

Do ambulatory patients with spinal cord injury walk symmetrically

Study design:Cross-sectional study.Objectives:To explore the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI), and compare levels of walking symmetry among those with different degrees of lesion severity and those who walked with various types of walking devices.Setting:A tertiary rehabilitation center and many communities in Thailand.Methods:Forty-six participants were assessed for their demographics, SCI characteristics and types of walking device used. Then they were recorded for the ability of walking over a 10-m walkway using a digital camera. The levels of walking symmetry were analyzed using a method of manual digitization and reported in terms of percents of step length ratio.Results:Although the participants had bilateral sensorimotor impairments, they showed some degrees of walking asymmetry (~90%), particularly those with American Spinal Injury Association C (AIS C) (85%) and those who walked with a standard walker (78%). Their levels of walking symmetry also significantly differed from those with AIS D (92%; P<0.05) and those who walked without a walking device (95%; P<0.01).Conclusions:Walking symmetry has been reported as an important variable for the ability of well-controlled walking. Therefore, apart from levels of independent walking, rehabilitation professionals need to emphasize improvements in walking symmetry among these individuals.