Martha L. Walker

Efficacy of vestibular rehabilitation.

The purpose of this study was to determine significant changes in the Dizziness Handicap Inventory (DHI) scores in patients before and within 1 year after a vestibular rehabilitation program. Efficacy of a vestibular rehabilitation program was tested retrospectively in 37 patients by comparison of pretreatment and posttreatment DHI scores. A significant improvement in test scores was found, indicated by the Sign test at the 0.05 level after vestibular rehabilitation. This difference is evident in the total score and in the functional and physical subscore component. Prerehabilitation and postrehabilitation differences among diagnostic categories were analyzed by using the Kruskal-Wallis test. Patients with peripheral lesions demonstrated greater improvement in the emotional component of the DHI as compared with patients with central or mixed lesions. The Wilcoxon two-sample test assessed the influence of compliance with a home exercise program after discharge from a vestibular physical therapy program. There was no significant difference in improvement between patients who performed home exercises for at least a month after discharge and those who did not.

Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

UNLABELLED Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects. OBJECTIVE To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke. DESIGN A before-after comparison of a single group with BWSTT intervention. SETTING University research laboratory. PARTICIPANTS A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study. INTERVENTION Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback. MAIN OUTCOME MEASURES Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed. RESULTS One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s. CONCLUSIONS A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.

Reference Group Data for the Functional Gait Assessment

Background and Purpose: The Functional Gait Assessment (FGA) is a clinical tool for evaluating performance in walking. The purpose of this study was to determine age-referenced norms for performance on the FGA in community-living older adults. Subjects: Subjects were 200 adults, ages 40 to 89 years, living independently. Methods: Each subject completed the FGA one time and was scored simultaneously by 2 testers. Results: The intraclass correlation coefficient for interrater reliability was .93. Mean scores for the FGA ranged from 29/30 for adults in their 40s to 21/30 for adults in their 80s. Discussion and Conclusion: Patient performance on the FGA can be compared with age-referenced norms for expected performance. Further research is needed to determine the FGA’s usefulness in tracking clinical changes or predicting falls. The FGA is a reliable test for people without disease, and it is able to detect decreases in gait performance among typical older adults.

Relationship Between Foot Pressure Pattern and Foot Type

Foot type and location of area of peak pressure under the metatarsal heads were determined for 54 healthy adults between the ages of 21 and 39 years. Feet were classified as neutral, pronated, or supinated. Each subject walked barefoot over a pedobarograph, and the area of peak pressure was identified as being either medial, central, or lateral under the metatarsal heads. A Fishers exact test determined that there was a significant relationship between the area of peak pressure and foot type. A post hoc λ asymmetric test showed that the relationship was very weak. Nearly half (49%) of the feet were classified as neutral, 36% were pronated, and 15% were supinated. Pressure patterns were as follows: 62% central, 26% medial, and 12% lateral. Other factors besides foot type influence the area of peak pressure under the metatarsal heads.

Immediate effects of a heel-pain orthosis and an augmented low-dye taping on plantar pressures and pain in subjects with plantar fasciitis.

ObjectiveTo determine the effects of augmented low-dye (ALD) taping and a heel-pain orthosis (HPO) on pain, peak plantar pressure (PPP), and mean plantar pressure (MPP) while walking and jogging. DesignCross-over study design. SettingUniversity clinical laboratory. ParticipantsSeventeen physically active or sedentary individuals with plantar fasciitis. InterventionsBoth PPP and MPP were evaluated after 45 seconds of walking and jogging during the 3 interventions (control, ALD, HPO) under 4 areas of the foot: lateral rearfoot and forefoot, and medial rearfoot and forefoot. Pain was assessed during each intervention (at 60-second mark) using the visual analog scale (VAS). Main Outcome MeasuresPeak plantar pressure, MPP, and VAS. ResultsThe ALD produced a decrease in walking MPP (44.66 ± 14.46) under the lateral rearfoot compared with the control (57.92 ± 22.18; P = 0.024) and in jogging MPP (55.05 ± 18.27) compared with the control (67.22 ± 20.95; P = 0.002) and HPO (68.51 ± 17.57; P = 0.002). Scores of VAS decreased with the application of HPO (7.12 ± 10.08; P < 0.002 and 12.15 ± 15.61; P < 0.003) and ALD (6.24 ± 5.71; P < 0.006 and 10.09 ± 8.87; P < 0.001) while walking and jogging when compared with the control (17.32 ± 17.86 and 26.65 ± 22.38). ConclusionsAlthough the HPO and ALD produced statistically and clinically decreased VAS scores while walking and jogging, further research is needed beyond these preliminary findings to determine long-term outcomes related to pain relief.

PATELLOFEMORAL JOINT COMPRESSIVE FORCES DURING BACKWARD AND FORWARD RUNNING AT THE SAME SPEED

A previous study found that the patellofemoral joint compressive force (PFJRF) during backward running was less than during forward running at a self-selected speed. Therefore, the purpose of this study was to compare the patellofemoral joint compressive forces during backward and forward running at the same speed. Ten runners (four females, six males) between the ages of 20–25 (X=22.25, SD=2.25) ran in backward and forward directions at a very slow speed of 2.3 mph (1.0 ms-1). Using a mathematical model of patellofemoral joint that does not assume equal forces of the quadriceps and patellar tendon, the PFJRFs during the very slow backward and forward running were calculated. Results showed that the PFJRF and knee extensor moment during backward and forward running were similar. The PFJRF and knee extensor moment were 3.51 BW and 144.52 Nm, respectively, during the very slow backward running, and 3.41 BW and 141.60 Nm, respectively, during the very slow forward running. In conclusion, slow backward and forward running put similar compressive forces on the patellofemoral joint. Moreover, backward running does not protect the patellofemoral joint from higher compression forces, but very slow speed does.

Bracing of the trunk and neck has a differential effect on head control during gait

During gait, the trunk and neck are believed to play an important role in dissipating the transmission of forces from the ground to the head. This attenuation process is important to ensure head control is maintained. The aim of the present study was to assess the impact of externally restricting the motion of the trunk and/or neck segments on acceleration patterns of the upper body and head and related trunk muscle activity. Twelve healthy adults performed three walking trials on a flat, straight 65-m walkway, under four different bracing conditions: 1) control-no brace; 2) neck-braced; 3) trunk-braced; and 4) neck-trunk braced. Three-dimensional acceleration from the head, neck (C7) and lower trunk (L3) were collected, as was muscle activity from trunk. Results revealed that, when the neck and/or trunk were singularly braced, an overall decrease in the ability of the trunk to attenuate gait-related oscillations was observed, which led to increases in the amplitude of vertical acceleration for all segments. However, when the trunk and neck were braced together, acceleration amplitude across all segments decreased in line with increased attenuation from the neck to the head. Bracing was also reflected by increased activity in erector spinae, decreased abdominal muscle activity and lower trunk muscle coactivation. Overall, it would appear that the neuromuscular system of young, healthy individuals was able to maintain a consistent pattern of head acceleration, irrespective of the level of bracing, and that priority was placed over the control of vertical head accelerations during these gait tasks.