1,720,960 research outputs found
Effects of balance and gait rehabilitation in cerebellar disease of vascular or degenerative origin.
No full textPurpose: To investigate whether the response to rehabilitation differs between patients with abnormalities of balance and gait due to vascular or to degenerative cerebellar disease. Methods: We reviewed the outcome of 27 cerebellar patients. Fourteen patients with vascular and 13 with degenerative cerebellar disease underwent a 3-week inpatient physical therapy program for 5 days/week, 90 min/day, focused on balance and gait. Body sway area during quiet stance with eyes open and eyes closed, and gait velocity, stride length, cadence and step width were recorded. The Berg Balance Scale (BBS) and Functional Independence Measure (FIM) were administered. All tests were performed before and after treatment. Results: Before treatment, both groups showed comparable values in all sway and gait variables and in BBS. FIM score was higher in degenerative than vascular patients. After treatment, a significant reduction of body sway area was observed under both visual conditions in both groups. Gait velocity, stride length and step width improved more in the vascular than in the degenerative patient group. BBS improved in both groups. FIM improved to a larger extent in the vascular patients. Conclusion: Short-term treatment may not be sufficient to produce definite improvement in locomotion in degenerative as much as occurs in vascular patients, even if clinical and functional signs of balance improve in both groups
Test-retest reliability of an insole plantar pressure system to assess gait along linear and curved trajectories.
No full textBACKGROUND: Previous studies have assessed reliability of insole technology for evaluating foot pressure distribution during linear walking. Since in natural motion straight walking is intermingled with turns, we determined the test-retest reliability of insole assessment for curved as well as linear trajectories, and estimated the minimum number of steps required to obtain excellent reliability for each output variable. METHODS: Sixteen young healthy participants were recruited. Each performed, two days apart, two sessions of three walking conditions: linear (LIN) and curved, clockwise (CW) and counter-clockwise (CCW). The Pedar-X system was used to collect pressure distribution. Foot print was analyzed both as a whole and as subdivided into eight regions: medial and lateral heel, medial and lateral arch, I metatarsal head, II-V metatarsal heads, hallux, lateral toes. Reliability was assessed by using intraclass correlation coefficient (ICC) for clinically relevant variables from analysis of 50 steps per trajectory: Peak Force (PF); Peak Pressure (PP); Contact Area (CA); Stance Duration (S). RESULTS: When considering whole-foot, all variables showed an ICC >0.80, therefore highly reliable. This was true for both LIN and curved trajectories. There was no difference in ICC of the four variables between left and right foot. When collapsing foot and trajectories, S had a lower ICC than PP and CA, and PP lower than CA. Mean percent error between the values of first and second session was 0.90, indicating excellent reliability. In curved trajectories, S showed smaller ICCs. Since the least ICC value for S was 0.60 in LIN trajectory, we estimated that to achieve an ICC ≥0.90 more than 200 steps should be collected. CONCLUSIONS: High reliability of insole dynamic variables (PF, PP, CA) is obtained with 50 steps using the Pedar-X system. On the contrary, high reliability of temporal variable (S) requires a larger step number. The negligible differences in ICC between LIN and curved trajectory allow use of this device for gait assessment along mixed trajectories in both clinical and research setting
Afferent control of walking: are there distinct deficits associated to loss of fibres of different diameter?
No full textOBJECTIVES: To compare the gait pattern in patients affected by different types of neuropathy. METHODS: We recruited healthy subjects (HS, n=38), patients with Charcot-Marie-Tooth disease type 1A (CMT1A) (n=10) and patients with diabetic neuropathy (DNP) (n=12). Neuropathy impairment score and neuropathy score were assessed. Body sway during quiet stance, and spatio-temporal gait parameters were recorded. RESULTS: Most patients had reduced or absent tendon-tap reflexes. Strength of foot dorsiflexor muscles (p<0.05) and conduction velocity (CV) of leg nerves (p<0.0001) were more impaired in CMT1A than DNP, whereas joint-position sense was more affected (p<0.05) in DNP. Body sway while standing was larger in DNP compared to CMT1A and HS (p<0.01 and p<0.0001 respectively). During gait, the distribution of foot sole contact pressure was abnormal in CMT1A (p<0.05) but not in DNP. Velocity and step length were decreased, and foot yaw angle at foot flat increased, in DNP with respect to CMT1A and HS (both variables, p<0.001). Gait velocity and step length were decreased (p<0.005) also in CMT1A, but to a smaller extent than in DNP, so that the difference between patient groups was significant (p<0.0005). Duration of the double support was protracted in DNP compared to CMT1A and HS (p<0.0005). For DNP only, velocity of gait and duration of single support were correlated (p<0.05) both to sway path and lower limb muscle strength. CONCLUSIONS: Changes in both body sway and stance phase of gait were larger in DNP than CMT1A, indicating more impaired static and dynamic control of balance when neuropathy affects the small in addition to the large afferent fibres. Diminished somatosensory input from the smaller fibres rather than muscle weakness or foot deformity plays a critical role in the modulation of the support phase of gait.
SIGNIFICANCE: The analysis of balance and gait in patients with neuropathy can offer a tool for understanding the nature and functional impact of the neuropathy and should be included in their functional evaluation
The generation of centripetal force when walking in a circle: insight from the distribution of ground reaction forces recorded by plantar insoles.
No full textBACKGROUND: Turning involves complex reorientation of the body and is accompanied by asymmetric motion of the lower limbs. We investigated the distribution of the forces under the two feet, and its relation to the trajectory features and body medio-lateral displacement during curved walking. METHODS: Twenty-six healthy young participants walked under three different randomized conditions: in a straight line (LIN), in a circular clockwise path and in a circular counter-clockwise path. Both feet were instrumented with Pedar-X insoles. An accelerometer was fixed to the trunk to measure the medio-lateral inclination of the body. We analyzed walking speed, stance duration as a percent of gait cycle (%GC), the vertical component of the ground reaction force (vGRF) of both feet during the entire stance, and trunk inclination. RESULTS: Gait speed was faster during LIN than curved walking, but not affected by the direction of the curved trajectory. Trunk inclination was negligible during LIN, while the trunk was inclined toward the center of the path during curved trajectories. Stance duration of LIN foot and foot inside the curved trajectory (Foot-In) was longer than for foot outside the trajectory (Foot-Out). vGRF at heel strike was larger in LIN than in curved walking. At mid-stance, vGRF for both Foot-In and Foot-Out was higher than for LIN foot. At toe off, vGRF for both Foot-In and Foot-Out was lower than for LIN foot; in addition, Foot-In had lower vGRF than Foot-Out. During curved walking, a greater loading of the lateral heel occurred for Foot-Out than Foot-In and LIN foot. On the contrary, a smaller lateral loading of the heel was found for Foot-In than LIN foot. At the metatarsal heads, an opposite behaviour was seen, since lateral loading decreased for Foot-Out and increased for Foot-In. CONCLUSIONS: The lower gait speed during curved walking is shaped by the control of trunk inclination and the production of asymmetric loading of heel and metatarsal heads, hence by the different contribution of the feet in producing the body inclination towards the centre of the trajectory
Differenze nella risposta al trattamento riabilitativo dell’equilibrio e del cammino tra i pazienti con patologia cerebellare vascolare e degenerativa.
No full textComparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders
No full textBACKGROUND: Recently, a new tool for assessing dynamic balance impairments has
been presented: the 14-item Mini-BESTest.
OBJECTIVE: The aim of this study was to compare the psychometric performance of
the Mini-BESTest and the Berg Balance Scale (BBS).
DESIGN: A prospective, single-group, observational design was used in the study.
METHODS: Ninety-three participants (mean age=66.2 years, SD=13.2; 53 women, 40
men) with balance deficits were recruited. Interrater (3 raters) and test-retest
(1-3 days) reliability were calculated using intraclass correlation coefficients
(ICCs). Responsiveness and minimal important change were assessed (after 10
sessions of physical therapy) using both distribution-based and anchor-based
methods (external criterion: the 15-point Global Rating of Change [GRC] scale).
RESULTS: At baseline, neither floor effects nor ceiling effects were found in
either the Mini-BESTest or the BBS. After treatment, the maximum score was found
in 12 participants (12.9%) with BBS and in 2 participants (2.1%) with
Mini-BESTest. Test-retest reliability for total scores was significantly higher
for the Mini-BESTest (ICC=.96) than for the BBS (ICC=.92), whereas interrater
reliability was similar (ICC=.98 versus .97, respectively). The standard error of
measurement (SEM) was 1.26 and the minimum detectable change at the 95%
confidence level (MDC(95)) was 3.5 points for Mini-BESTest, whereas the SEM was
2.18 and the MDC(95) was 6.2 points for the BBS. In receiver operating
characteristic curves, the area under the curve was 0.92 for the Mini-BESTest and
0.91 for the BBS. The best minimal important change (MIC) was 4 points for the
Mini-BESTest and 7 points for the BBS. After treatment, 38 participants evaluated
with the Mini-BESTest and only 23 participants evaluated with the BBS (out of the
40 participants who had a GRC score of ≥ 3.5) showed a score change equal to or
greater than the MIC values.
LIMITATIONS: The consecutive sampling method drawn from a single rehabilitation
facility and the intrinsic weakness of the GRC for calculating MIC values were
limitations of the study.
CONCLUSIONS: The 2 scales behave similarly, but the Mini-BESTest appears to have
a lower ceiling effect, slightly higher reliability levels, and greater accuracy
in classifying individual patients who show significant improvement in balance
function
Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed
No full textBACKGROUND: Several patients with Parkinson ́s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases?
METHODS: We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated.
RESULTS: Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase.
CONCLUSION: The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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