Paula H. Lobo da Costa

Gait Training Combining Partial Body-Weight Support, a Treadmill, and Functional Electrical Stimulation: Effects on Poststroke Gait

Background and Purpose: Treadmill training with harness support is a promising, task-oriented approach to restoring locomotor function in people with poststroke hemiparesis. Although the combined use of functional electrical stimulation (FES) and treadmill training with body-weight support (BWS) has been studied before, this combined intervention was compared with the Bobath approach as opposed to BWS alone. The purpose of this study was to evaluate the effects of the combined use of FES and treadmill training with BWS on walking functions and voluntary limb control in people with chronic hemiparesis. Subjects: Eight people who were ambulatory after chronic stroke were evaluated. Methods: An A1-B-A2 single-case study design was applied. Phases A1 and A2 included 3 weeks of gait training on a treadmill with BWS, and phase B included 3 weeks of treadmill training plus FES applied to the peroneal nerve. The Stroke Rehabilitation Assessment of Movement was used to assess motor recovery, and a videography analysis was used to assess gait parameters. Results: An improvement (from 54.9% to 71.0%) in motor function was found during phase B. The spatial and temporal variables cycle duration, stance duration, and cadence as well as cycle length symmetry showed improvements when phase B was compared with phases A1 and A2. Discussion and Conclusions: The combined use of FES and treadmill training with BWS led to an improvement in motor recovery and seemed to improve the gait pattern of subjects with hemiparesis, indicating the utility of this combination method during gait rehabilitation. In addition, this single-case series showed that this alternative method of gait training—treadmill training with BWS and FES—may decrease the number of people required to carry out the training.

Effects of treadmill-walking training with additional body load on quality of life in subjects with Parkinson's disease

BACKGROUND Parkinsons disease (PD) causes motor and non-motor impairments that affect the subjects quality of life. OBJECTIVE To assess the effects of treadmill-walking training with additional body load on the quality of life and motor function of subjects with PD. METHODS Nine subjects with PD, Hoehn and Yahr stages 2-3, not demented and with capability to ambulate independently took part in this study. The training program was divided into three phases (A₁-B-A₂): treadmill training with additional body load (A₁), control condition (conventional physical therapy group; B) and a second period of treadmill training with load (A₂). Each phase lasted six weeks. Quality of life and motor function were assessed by the PDQ-39 and the motor score of the Unified Parkinsons Disease Rating Scale (UPDRS), respectively. The evaluations and the training were performed during the on-phase of the medication cycle. RESULTS There was improvement in the total PDQ-39 score across the training period. The subscores mobility, activities of daily living and cognition subscores significantly improved after the training period. The improvement in the total score was associated with motor and non-motor factors in all of the training phases. The UPDRS motor score also improved, however it did not present any association with the improvement in quality of life. CONCLUSIONS The results showed that the treadmill-walking training with additional body load allowed an improvement in motor and non-motor aspects related to quality of life and motor function in subjects with PD.

Single leg balancing in ballet: Effects of shoe conditions and poses

The purpose of this study was to describe the effects of lower limb positioning and shoe conditions on stability levels of selected single leg ballet poses performed in demi-pointe position. Fourteen female non-professional ballet dancers (mean age of 18.4±2.8 years and mean body mass index of 21.5±2.8kg/m(2)) who had practiced ballet for at least seven years, without any musculoskeletal impairment volunteered to participate in this study. A capacitive pressure platform allowed for the assessment of center of pressure variables related to the execution of three single leg ballet poses in demi pointé position: attitude devant, attitude derriére, and attitude a la second. Peak pressures, contact areas, COP oscillation areas, anterior-posterior and medio-lateral COP oscillations and velocities were compared between two shoe conditions (barefoot versus slippers) and among the different poses. Barefoot performances produced more stable poses with significantly higher plantar contact areas, smaller COP oscillation areas and smaller anterior-posterior COP oscillations. COP oscillation areas, anterior-posterior COP oscillations and medio-lateral COP velocities indicated that attitude a la second is the least challenging and attitude derriére the most challenging pose.

Variations in dynamic knee valgus and gluteus medius onset timing in non-athletic females related to hormonal changes during the menstrual cycle ☆

It has been suggested that activities of daily living could contribute to the occurrence of ACL injury in females. Currently, no studies have focused on the lower extremity behavior of a non-athletic population to compare or understand the lower extremity adeptness towards daily movements that mimic athletic tasks. Our hypothesis was that increased knee valgus angles would occur during the late follicular phase of the menstrual cycle accompanied by different onset timing of the gluteus medius muscle. In a controlled laboratory study, 23 non-athletic collegiate females participated and 15 subjects comprised the final sample for statistical analysis. Subjects performed a single leg drop landing maneuver while 3-D knee kinematics and gluteus medius muscle onset timing were assessed throughout three distinct phases of the menstrual cycle, confirmed by blood hormone analysis. In general, knee valgus angles were significantly less in the luteal phase compared to both follicular phases (p<0.005), while differences were not observed for gluteus medius onset timing (p=0.936). As a decreased knee joint valgus angle was observed during the luteal phase, it was hypothesized that the hormone progesterone could significantly influence knee kinematics during a dynamic task. However, such influence was not observed for gluteus medius EMG onset timing as a significant correlation between gluteus medius onset timing and knee valgus angle could not be determined.

Anticipatory phase of gait initiation on horizontal, upward and downward inclined surfaces

This paper presents a study of the center of pressure (COP) behavior during anticipatory postural adjustments phase (APA) of gait initiation in different conditions which are commonly required in daily activities. Twelve young subjects enrolled in this study and performed gait initiation in horizontal and upward and downward inclined surfaces. Significant differences were found only in the mediallateral (ML) displacement and velocity of COP on both inclined surfaces. These results suggest a smaller transfer of the center of mass to the support foot in this phase on inclined surfaces. This should be taken in account in the design of bipedal robots once the ML COP control is an important aspect of gait initiation.