Mansoo Ko

Walking speed and peak plantar pressure distribution during barefoot walking in persons with diabetes

BACKGROUND The impact of walking speed has not been evaluated as a feasible outcome measure associated with peak plantar pressure (PPP) distribution, which may result in tissue damage in persons with diabetic foot complications. The objective of this pilot study was to determine the walking speed and PPP distribution during barefoot walking in persons with diabetes.  METHODS  Nine individuals with diabetes and nine age-gender matched individuals without diabetes participated in this study. Each individual was marked at 10 anatomical landmarks for vibration and tactile pressure sensation tests to determine the severity of sensory deficits on the plantar surface of the dominant limb foot. A steady state walking speed, PPP, the fore and rear foot (F/R) PPP ratio and gait variables were measured during barefoot walking.  RESULTS  Persons with diabetes had a significantly slower walking speed than the age-gender matched group resulting in a significant reduction of PPP at the F/R foot during barefoot walking (p < 0.05). There was no significant difference in F/R foot PPP ratio in the diabetic group compared with the age-gender matched group during barefoot walking (p > 0.05). There was a significant difference between the diabetic and non-diabetic groups for cadence, step time, toe out angle and the anterior-posterior excursion (APE) for centre of force (p < 0.05).  CONCLUSION  Walking speed may be a potential indicator for persons with diabetes to identify PPP distribution during barefoot walking in a diabetic foot. However, the diabetic group demonstrated a more cautious walking pattern than the age-gender matched group by decreasing cadence, step length and APE, and increasing step time and toe in/out angle. People with diabetes may reduce the risk of foot ulcerations as long as they are able to prevent severe foot deformities such as callus, hammer toe or charcot foot.

Effects of Limb Loading on Gait Initiation in Persons with Moderate Hemiparesis

Abstract Purpose: To examine the immediate effect of symmetrical weight bearing (SWB) on temporal events of gait initiation (GI) patterns and timing and amplitude of lower distal limb muscles activity during GI in persons with hemiparesis. Method: The study was a within-subjects design. Twelve persons with hemiparesis were recruited from the Veterans Affairs Brain Rehabilitation Research Center at the Malcom Randall Veterans Affairs, Gainesville, Florida. GI trials were performed from 4 beginning limb-loading conditions presented in a randomized order: (1) GI with the paretic limb during natural (asymmetrical) weight bearing (NWB); (2) GI with the nonparetic limb during NWB; (3) GI with the paretic limb during SWB; and (4) GI with the nonparetic limb during SWB. Temporal events of ground reaction forces (GRFs) and timing and amplitude of distal muscles activity were measured during GI trials in a motion analysis laboratory. Results: There were no significant effects of SWB on the temporal events of GRFs and timing and amplitude of distal muscles activity when initiating gait with the paretic limb. Onset of tibilais anterior (TA) muscle was delayed significantly with less amplitude when initiating gait with the paretic limb in both NWB and SWB conditions. However, when initiating gait with the nonparetic limb, TA muscle on the paretic limb was activated normally with greater amplitude in both NWB and SWB conditions. Conclusion: Initiating gait with the nonparetic limb as pregait activity may more effectively challenge the dynamic balance for a symmetrical gait pattern than the standard SWB in persons with hemiparesis.

Effect of revised high-heeled shoes on foot pressure and static balance during standing

[Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance.

Gait Speed Improves During Physical Therapy in General Acute Care, Skilled Nursing, and Inpatient Rehabilitation - a Pilot Study

Objective: To describe gait speed and gait speed changes that occurred in patients who received physical therapy in general health care settings of acute care, skilled nursing, and inpatient rehabilitation settings. Design: Pre‐post observational cross‐sectional study of changes in gait speed. Setting: Acute care, skilled nursing, and inpatient rehabilitation facilities of a regional medical center in the United States. Participants: Individuals (n=110) admitted with physical therapy referrals with full weight bearing status who could ambulate 20 feet and consented to participate. Main Outcome Measure: Change in gait speed from initial visit to therapy discharge. Results: Two‐way mixed ANOVA determined that mean gait speed improved significantly between initial and discharge time points (p<.001). An interaction effect between gait speed and health care settings (p<.001), indicated varying levels of speed achieved across different health care settings. Post hoc tests using Bonferroni adjustments showed acute care discharge gait speed was not significantly different from skilled nursing (p=0.352), but inpatient rehabilitation was significantly different from both acute care (p<.001) and skilled nursing (p=0.02) units. Paired t‐tests of the individual health care settings revealed that gait speed was significantly improved in acute care [initial vs. discharge; 0.31(0.22) vs. 0.38 (0.21) m/s], skilled nursing [0.36 (0.19) vs. 0.61(0.39) m/s], and inpatient rehabilitation [0.60( 0.70) vs. 0.98 (0.72) m/s]. Minimal detectable change for gait speed was 0.16m/s in acute care, 0.14m/s in skilled nursing, and 0.51m/s inpatient rehabilitation. Conclusions: Self‐selected gait speed is an informative measure. Gait speed improved from physical therapy initial evaluation to discharge in 3 different health care settings. In acute care, gait speeds improved over a short course of therapy, but these speeds would still be considered to be slow relative to community requirements. In skilled nursing and inpatient rehabilitation, patients achieve gait speeds required for limited community level ambulation.

Comparison of joint angles and electromyographic activity of the lower extremities during standing with wearing standard and revised high-heeled shoes: A pilot study

Revised high-heeled shoes (HHSs) were designed to improve the shortcomings of standard HHSs. This study was conducted to compare revised and standard HHSs with regard to joint angles and electromyographic (EMG) activity of the lower extremities during standing. The participants were five healthy young women. Data regarding joint angles and EMG activity of the lower extremities were obtained under three conditions: barefoot, when wearing revised HHSs, and when wearing standard HHSs. Lower extremity joint angles in the three dimensional plane were confirmed using a VICON motion capture system. EMG activity of the lower extremities was measured using active bipolar surface EMG. Kruskal-Wallis one-way analysis of variance by rank applied to analyze differences during three standing conditions. Compared with the barefoot condition, the standard HHSs condition was more different than the revised HHSs condition with regard to lower extremity joint angles during standing. EMG activity of the lower extremities was different for the revised HHSs condition, but the differences among the three conditions were not significant. Wearing revised HHSs may positively impact joint angles and EMG activity of the lower extremities by improving body alignment while standing.

The Effectiveness of Incorporating a Play-based Intervention to Improve Functional Mobility for a Child with Relapsed Acute Lymphoblastic Leukaemia: A Case Report

BACKGROUND AND PURPOSE Acute lymphoblastic leukaemia (ALL) is one of the most common forms of cancer seen in children, accounting for one-fourth of all childhood cancers. These children typically present with decreased functional mobility, weakened lower extremity muscle strength and reduced exercise endurance and interests because of disease progressions and chemotherapy treatments. The purpose of this case report was to examine the effectiveness of incorporating a play-based physical therapy (PT) intervention programme to improve functional mobility for an inpatient with relapsed ALL undergoing chemotherapy. CASE DESCRIPTION The patient was a 3-year-old male admitted to the hospital for relapsed ALL. He was diagnosed approximately 1 year earlier for which he had undergone chemotherapy and was later considered in remission at that time. When the patient relapsed, he underwent another round of chemotherapy and was waiting for a bone marrow transplant during his treatment during the course of this case report. For PT intervention, therapeutic exercises were incorporated into play to strengthen his lower extremity strength and muscle endurance. Functional activities were also incorporated into play to improve his aerobic capacity and overall quality of life. Multi-attribute health status classification system (HUI3) utility scores, 6-minute walk test distance (6MWT), lower extremity (LE) strength, transfer and tolerated treatment time were assessed to identify the effect of a PT intervention. OUTCOMES Despite experiencing fatigue, the patient completed most of the treatments incorporated into play. After 5 weeks of PT intervention, the participant improved on HUI3 (pre: 0.72 and post: 0.92), 6MWT (pre: 156 ft and post: 489 ft), LE strength (squat), transfer (sit to stand) and tolerated treatment time (pre: 16 minutes and post: 44 minutes). DISCUSSION This case report suggests that incorporating a play-based PT intervention programme could be physically tolerable and functionally beneficial for a young child with relapsed ALL undergoing inpatient chemotherapy. Copyright

The influence of revised high-heeled shoes on foot pressure and center of pressure during standing in young women.

[Purpose] Revised high-heeled shoes were developed to minimize foot deformities by reducing excessive load on the forefoot during walking or standing in adult females, who frequently wear standard high-heeled shoes. Specifically, this study aimed to investigate the effects of revised high-heeled shoes on foot pressure distribution and center of pressure distance during standing in adult females. [Subjects and Methods] Twelve healthy adult females were recruited to participate in this study. Foot pressures were obtained under 3 conditions: barefoot, in revised high-heeled shoes, and in standard 7-cm high-heeled shoes. Foot pressure was measured using the Tekscan HR mat scan system. One-way repeated analysis of variance was used to compare the foot pressure distribution and center of pressure distance under these 3 conditions. [Results] The center of pressure distance between the two lower limbs and the fore-rear distribution of foot pressure were significantly different for the 3 conditions. [Conclusion] Our findings support the premise that wearing revised high-heeled shoes seems to provide enhanced physiologic standing posture compared to wearing standard high-heeled shoes.

Comparison of the effects on dynamic balance and aerobic capacity between objective and subjective methods of high-intensity robot-assisted gait training in chronic stroke patients: a randomized controlled trial.

Abstract Background: Robot-assisted gait training (RAGT) is effective for improving dynamic balance and aerobic capacity, but previous RAGT method does not set suitable training intensity. Recently, high-intensity treadmill gait training at 70% of heart rate reserve (HRR) was used for improving aerobic capacity and dynamic balance. Purpose: This study was designed to compare the effectiveness between objective and subjective methods of high-intensity RAGT for improving dynamic balance and aerobic capacity in chronic stroke. Methods: Subjects were randomly allocated into experimental (n = 17) and control (n = 17) groups. The experimental group underwent high-intensity RAGT at 70% of HRR, whereas the control group underwent high-intensity RAGT at an RPE of 15. Both groups received their assigned training for 30 min per session, 3 days per week for 6 weeks. All subjects also received an additional 30 min of conventional physical therapy. Before and after each of the 18 sessions, the dynamic balance and aerobic capacity of all subjects were evaluated by a blinded examiner. Results: After training, Berg Balance Scale (BBS) and Timed Up and Go Test scores, VO2max, and VO2max/kg were significantly increased in both groups (p < 0.05). These variables in experimental group were significantly greater than control group. However, the BBS score was not significantly different between both groups. All subjects completed high-intensity RAGT. No adverse effect of training was observed in both groups. Conclusion: High-intensity RAGT at 70% of HRR significantly improved dynamic balance and aerobic capacity more than RAGT at RPE of 15. These results suggest that high-intensity RAGT at 70% of HRR is safe and effective for improving dynamic balance and aerobic capacity in chronic stroke.

Effect of bilateral step-up and -down training on motor function in a person with hemiparesis: a case report.

Abstract Gait training to facilitate the use of the paretic limb for persons with hemiparesis continues to be of interest to those in the clinical research domain. The purpose of this case report was to assess the outcomes of a repeated step-up and -down treatment, initiating with the paretic limb, on functional mobility, endurance and gait kinematic parameters in a person with hemiparesis. The participant was an 85-year-old female 3 years status post left hemiparesis, who reported overall good health. The participant was asked to step up on a 1-inch height wood box with her paretic limb. Once both feet were on top of the box, the participant initiated descent also with her paretic limb. The height of the box gradually progressed to 5 inches based on the participant’s performance and tolerance. A metronome was used to facilitate rhythmic lower extremity movement patterns. The training duration for each treatment session was 7–15 min/day. The participant completed nine sessions spanning over 3 weeks. The outcome measure used to identify motor recovery was the Fugl-Myer (lower extremity). In addition, the timed up and go (TUG), the 6-min walk test (6 MWT) and gait kinematics were assessed to examine mobility and gait. The Fugl-Myer score and 6 MWT did not reflect a meaningful change (0% and +2.6%, respectively). However, TUG scores did show a meaningful change (+31.9%). With respect to gait kinematics, hip flexion on the paretic limb was improved from 11° to 18°, which indicates the normal range of hip motion during the initial swing phase in post-test.

Dynamic Postural Control in Older People With Diabetes During Gait Initiation

ABSTRACT The purpose of the study was to investigate whether older people with diabetes exhibit different temporal characteristics related to postural control during gait initiation (GI) from age-matched healthy individuals. Eighteen participants were recruited and divided into two groups: nine people with diabetes and nine age/gender-matched people without diabetes. Participants performed the task of GI along 10m walkway on Tek-Scan® with bare feet. The temporal events of foot position were identified from ground reaction forces during five GI trials. For the absolute temporal events, our results show the anticipatory postural adjustment (APA) in the diabetic group was significantly longer than the nondiabetic group during GI. Despite having a longer APA for participants with diabetes, the relative temporal events of the diabetic group were not significantly different from the nondiabetic group during GI, which suggests that the feedforward control of GI remains unaffected after diabetes.