Journal of Neurologic Physical Therapy最新文献

Background and objective: There has been a substantial increase in the number of studies demonstrating improvements in walking capacity in people with chronic stroke following moderate-to-high intensity walking exercise interventions. Yet, there is significant variability in response to these interventions. This is likely due to the heterogeneity in this population and the variability in the exercise dose parameters actually attained within these walking interventions. Exercise prescription can be optimized by understanding how individual variables impact walking exercise dose. This study leveraged a large, clinical dataset to classify people with chronic stroke into homogeneous groups (called classes) and compare classes on the walking exercise dose achieved in a walking intervention.

Methods: One hundred sixty-nine people with chronic (>6-Months) stroke completed clinical evaluations and a 12-week high-intensity treadmill intervention. Baseline measures of walking capacity, physical health, and psychosocial factors were used in a latent variable mixture model to assess if latent, homogeneous classes existed within the dataset. Objective criteria determined the optimal number of classes, which were compared to the walking exercise dose attained across the intervention.

Results: Four homogeneous classes were distinguished by differences in baseline walking capacity, steps-per-day, comorbidity burden, and balance self-efficacy. Despite clear "clinical profiles" of people with chronic stroke, these classes did not differ on the walking exercise dose attained.

Discussion and conclusions: Prior literature and clinical intuition suggest individuals with lower baseline walking capacity, physical health, and self-efficacy are less likely to tolerate high-intensity exercise, however our results demonstrate this is not true for people with chronic stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A524 .

Background and purpose: Gait dysfunction in people with Parkinson disease (PwPD) is common and debilitating. Internal cues (ie, mental singing) may provide a useful alternative to external cueing (ie, listening to music) to improve walking for PwPD. In this study, we individually tailored cues to each participant by allowing them to choose their own cue song and by selecting the cue rate that elicited the longest strides.

Methods: Fifty-six participants (28 controls and 28 PwPD) performed walking trials in a single-session, cross-sectional study. Initially, uncued trials were compared with cued conditions in which participants walked to music or while they mentally sang at 4 randomized cue rates (90%, 100%, 110%, and 120% of uncued walking cadence). Participants chose their songs from a curated catalog. Cues were optimized according to longest stride lengths as measured by APDM wearable sensors. Repeated measures Analysis of Variance assessed differences between gait characteristics (velocity, cadence, and stride length) and gait variabilities (coefficients of variations) across conditions and groups.

Results: Both cue types improved velocity, cadence, and stride length as compared to uncued walking. Internal cues were most beneficial to gait variability. The majority of participants exhibited the longest strides and fastest velocities at the highest cue rate of 120%, though a cue rate of 110% was most beneficial to gait variability.

Discussion and conclusions: This study shows how internal and external cues personalized by song choice and cue rate may be tailored to individuals. The information gained may help tailor cues to optimize gait performance for older adults and PwPD.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A518 ).

Background: Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception's role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers.

Methods: Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure.

Results: Significant correlations were seen for vibration sensation and FW comfortable ( ρ  = 0.35), FW fast ( ρ  = 0.34), BW comfortable ( ρ  = 0.46), and BW fast ( ρ  = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β  = 0.57; fast β  = 0.58) compared to FW (comfortable β  = 0.41; fast β  = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation ( P = 0.04).

Discussion and conclusions: Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention.

Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490 ).

Background and purpose: Walking and participation in the community are important goals for people post-stroke (PPS). These constructs are challenging to measure given limitations in current data collection methodologies. The purpose of this study was to (1) develop a data fusion approach that combined data from global positioning system (GPS), activity monitor (AM), and daily trip log to identify walking activity and participation in the community, and (2) to examine the construct validity of the data fusion method.

Methods: At 60 days post-stroke, PPS wore a GPS and AM and completed a daily trip log for 7 days. Using a combination of a density-based spatial clustering algorithm and geocoding GPS, AM, and daily trip log data were time synched and fused to identify total trips taken outside the home; locations visited per trip; number of steps taken in the home, in the community, at each location visited, and in total. Associations between stroke outcomes and the data fusion metrics were determined to support the construct validity of the data fusion method.

Results: Forty-four PPS took a mean of 2,541 steps/day, of which 56% were in the community, and took a mean of 0.39 trips/day outside the home and visited a mean of 0.42 locations. A social visit was the most common reason for going into the community. There were fair associations between number of trips outside the home and gait speed (GS), r = 0.49, Berg Balance Scale (BBS), r = 0.48, modified Rankin Scale (mRS), r = -0.47, and Stroke Impact Scale participation subscale (SIS-P) (0.45). There were moderate associations between steps taken in the community and GS, r = 0.63, BBS, r = 0.51, mRS, r = -0.61, and SIS-P, r = 0.43.

Discussion and conclusions: Participants did not often access their community. Fusing GPS, AM, and trip log data may provide a comprehensive method to identify walking activity and community participation in PPS.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A529 ).

Background and purpose: Neurorehabilitation research utilizes wearable technology (WT) and mobile phone apps (MPA) to measure gait and walking activity in people with various neurological conditions. Despite physical therapists' perceptions that WT is useful, the reported use of WT in clinical practice remains low. The purpose of this brief review is to discuss the advantages of WT and MPA for gait assessment in the clinical setting, highlight WT and MPA that are available for clinical use, and acknowledge the limitations and future potential of these technologies in patient care.

Summary of key points: WT and MPA provide objective assessments of gait characteristics or physical activity that is low-cost, easy to use, and a beneficial adjunct to traditional clinical methods. There are several WT and MPA that have been validated in persons with neurological conditions and help identify gait impairments and discriminate fallers from non-fallers. Although additional research is needed to overcome continued barriers to use in clinical practice, WT and MPA have potential as tools to provide objective feedback to patients and influence clinical decision making.

Recommendations for clinical practice: There are many advantages to using WT or MPA to measure gait and walking activity in persons with neurologic conditions. We anticipate that these technologies will only become more pervasive in research and practice and recommend that clinicians consider applying these technologies in their own practice.

Background and Purpose: Lower limb (LL) weakness and gait impairment are prevalent among persons with multiple sclerosis (PwMS) and can impede functional independence and impact health-related quality of life (HR-QoL). The purpose of this study was to examine the mediation effect of walking speed and perceived walking ability on the relationship between LL weakness and HR-QoL in ambulatory PwMS.

Methods: Participants (n = 175) were PwMS in this secondary analysis of a cross-sectional study. Demographics, pain (visual analog scale), fatigue (5-item Modified Fatigue Impact Scale), LL strength (hip extensors [HE] and flexors [HF], knee extensors [KE] and flexors [KF], and ankle plantarflexors [APF] and dorsiflexors [ADF]), Timed 25-Foot Walk, 12-item MS Walking Scale, and HR-QoL (MS Impact Scale-Physical [MSIS-29-Phys] and Psychological [MSIS-29-Psych]) were collected. Bivariate and mediation analyses using Hayes' PROCESS were performed to determine if LL strength had an indirect effect through walking speed or perceived walking ability on physical and psychological HR-QoL while controlling for fatigue and pain.

Results: There were significant ( P < 0.01) correlations for all strength measures with the MSIS-29-Phys and for HF, KE, KF, and APF with the MSIS-29-Psych. In the mediation analyses, LL strength indirectly influenced PwMS' MSIS-29-Phys through walking speed and perceived walking ability. There was only partial mediation between HE, HF, KF, ADF, and MSIS-29-Phy when walking speed was in the model. LL strength did not influence MSIS-29-Psych.

Discussion and conclusions: LL strength impacts physical HR-QoL through walking but does not indirectly affect PwMS' perceived psychological HR-QoL. These findings may prompt physical therapists to create individualized care plans that address LL weakness and walking impairments with the goal of promoting optimal outcomes and improving HR-QoL.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A504 ).