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Over-ground walking in Parkinson’s disease: A pilot study utilizing a portable metabolic analyzer  [PDF]
Alyssa D. Stookey, Frederick M. Ivey, Jessica E. Hammers, Lisa M. Shulman, Karen Anderson, Leslie I. Katzel
Health (Health) , 2012, DOI: 10.4236/health.2012.431170
Abstract: Alterations in gait biomechanics are common during early stages of Parkinson’s disease (PD), potentially elevating energy requirements of walking and leading to impaired economy of gait. Although gait economy is traditionally assessed during treadmill walking with simultaneous ox-ygen consumption (VO2) monitoring, treadmill gait mechanics, particularly in PD, may be different from over-ground walking mechanics, possibly providing a distorted picture of true gait economy. Currently, no studies have directly examined the energy cost of over-ground walking in PD patients. The purpose of this study was to test the feasibility of measuring energy expenditure during over-ground walking in mild to moderate PD using portable gas exchange monitoring technology. Additionally, we sought to determine whether energy expenditure, as assessed through VO2 measures, related to disease severity for PD. Seventeen PD patients underwent separate 6-minute walk (6MW) tests both with and without the COSMED K4b2 portable oxygen monitoring system. Gait economy was calculated as measured VO2 during 6MW divided by the predicted VO2 for non-PD age-matched subjects, according to a standard estimation equation utilizing ground speed. Distance covered during the 6MW with the portable system (420 ± 12 meters) was highly correlated (r = 0.96, p < 0.001) to distance without the system (442 ± 135 meters) indicating that the lightweight equipment did not confound walking ability in these participants. Mean VO2 during the 6MW (16.0 ± 5.5 mL/kg/min) was 74% of mean VO2 peak for this sample, and 16 out of 17 subjects had impaired gait economy. The degree of gait economy impairment was not related to scores on either UPDRS total or motor. Our results demonstrate that PD patients use extraordinarily high percentage of VO2 peak for normal floor walking, and show impaired gait economy relative to prediction equations. Interestingly, the degree of elevated energy expenditure during gait did not relate to disease severity.
Six-Minute Walk Test in Patients with Rheumatoid Arthritis  [PDF]
Sandor Balsamo, Ana Paula Monteiro Gomides, Licia Maria Henrique da Mota, Frederico Santos de Santana, Raphaela Franco Miranda, Talita Yokoy, Luciana Muniz, Leopoldo Luiz Santos-Neto
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2019, DOI: 10.4236/ojra.2019.91002
Abstract: Background: The 6-minute walk test (6TC) was initially used as an instrument for assessing physical and cardiorespiratory capacity, but is currently being used to monitor treatments, and compare physical interventions and prognostic evaluation. Although already recognized as a research method in several specialties, 6TC has not been used in rheumatology. Patients with rheumatoid arthritis (RA) may have impaired functional capacity as well as increased cardiovascular mortality. An adequate functional evaluation of these patients is necessary and the 6TC may be useful in this sense. Objective: The aim of this study was to perform the 6-minute walk test in RA patients and to compare the performance with a control group. Method: A cross-sectional study was carried out in which the sample consisted of 85 women, 46 patients with rheumatoid arthritis and 39 healthy controls. A descriptive analysis of the data was performed. One-Way ANOVA methodology was used to compare the patient and control groups followed by the graphic analysis. Results: The distance walked on the 6TC by RA patients was on average 522.2 meters. In the distance control group found in the 6TC was on average 628.8 meters, the difference being statistically significant. Conclusion: In this study the distance covered in 6TC by women with RA was lower than that of healthy women of the same age.
Changes in spatiotemporal gait variables over time during a test of functional capacity after stroke
Kathryn M Sibley, Ada Tang, Kara K Patterson, Dina Brooks, William E McIlroy
Journal of NeuroEngineering and Rehabilitation , 2009, DOI: 10.1186/1743-0003-6-27
Abstract: 24 community dwelling, independently ambulating individuals greater than 3 months after stroke performed the Six-Minute Walk Test (6MWT). Participants walked over a pressure-sensitive mat on each pass of the 30 m course which recorded spatial and temporal parameters of gait. Mean gait speed and temporal symmetry ratio during each two-minute interval of the 6MWT were examined. Additional post hoc analyses examined the incidence of rests during the 6MWT and changes in gait speed and symmetry.On average, participants demonstrated a 3.4 ± 6.5 cm/s decrease in speed over time (p= 0.02). Participants who rested were also characterized by increased asymmetry in the final two minutes (p= 0.05). 30% of participants rested at some point during the test, and if a rest was taken, duration increased in the final two minutes (p= 0.001). Examination of factors which may have been associated with resting indicated that resters had poorer balance (p= 0.006) than non-resting participants.This study supports previous findings establishing that walking performance after stroke declines over relatively short bouts of functionally-relevant ambulation. Such changes may be associated with both cardiorespiratory and muscular fatigue mechanisms that influence performance. The findings also indicate that rest duration should be routinely quantified during the 6MWT after stroke, and consequently, further research is necessary to determine how to interpret 6MWT scores when resting occurs.Sensorimotor control is commonly impaired following stroke, and such changes in strength and coordination can significantly affect gait [1]. Gait impairments influence functional ambulation – the capacity to perform walking during activities of daily living – and are compounded by low cardiorespiratory fitness in stroke survivors [2,3]. Furthermore, fatigue is a commonly reported issue after stroke [4,5], and cardiorespiratory and muscular components of fatigue may mutually reinforce one another. For example, b
Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people
Claudine J Lamoth, Floor J van Deudekom, Jos P van Campen, Bregje A Appels, Oscar J de Vries, Mirjam Pijnappels
Journal of NeuroEngineering and Rehabilitation , 2011, DOI: 10.1186/1743-0003-8-2
Abstract: Thirteen elderly with dementia (mean age: 82.6 ± 4.3 years) and thirteen without dementia (79.4 ± 5.55) recruited from a geriatric day clinic, walked at self-selected speed with and without performing a verbal dual task. The Mini Mental State Examination and the Seven Minute Screen were administered. Trunk accelerations were measured with an accelerometer. In addition to walking speed, mean, and variability of stride times, gait stability was quantified using stochastic dynamical measures, namely regularity (sample entropy, long range correlations) and local stability exponents of trunk accelerations.Dual tasking significantly (p < 0.05) decreased walking speed, while stride time variability increased, and stability and regularity of lateral trunk accelerations decreased. Cognitively impaired elderly showed significantly (p < 0.05) more changes in gait variability than cognitive intact elderly. Differences in dynamic parameters between groups were more discerned under dual task conditions.The observed trunk adaptations were a consistent instability factor. These results support the concept that changes in cognitive functions contribute to changes in the variability and stability of the gait pattern. Walking under dual task conditions and quantifying gait using dynamical parameters can improve detecting walking disorders and might help to identify those elderly who are able to adapt walking ability and those who are not and thus are at greater risk for falling.One in three community-dwelling persons over 65 years of age falls at least once a year and this rate increases rapidly with age, and frailty [1]. Gait and balance disorders are suggested to better predict imminent falls than risk factors in other domains such as impaired vision and medication [1,2]. Therefore, the objective quantification of gait and balance disorders to detect persons who have high risk of falls is of utmost importance, especially in geriatric patients with cognitive decline who have a high t
Are the 10 Meter and 6 Minute Walk Tests Redundant in Patients with Spinal Cord Injury?  [PDF]
Gail F. Forrest, Karen Hutchinson, Douglas J. Lorenz, Jeffrey J. Buehner, Leslie R. VanHiel, Sue Ann Sisto, D. Michele Basso
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0094108
Abstract: Objective To evaluate the relationship and redundancy between gait speeds measured by the 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) after motor incomplete spinal cord injury (iSCI). To identify gait speed thresholds supporting functional ambulation as measured with the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI). Design Prospective observational cohort. Setting Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Participants 249 NRN patients with American Spinal Injury Association Impairment Scale (AIS) level C (n = 20), D (n = 179) and (n = 50) iSCI not AIS evaluated, from February 2008 through April 2011. Interventions Locomotor training using body weight support and walking on a treadmill, overground and home/community practice. Main Outcome Measure(s) 10MWT and 6MWT collected at enrollment, approximately every 20 sessions, and upon discharge. Results The 10MWT and 6MWT speeds were highly correlated and the 10MWT speeds were generally faster. However, the predicted 6MWT gait speed from the 10MWT, revealed increasing error with increased gait speed. Regression lines remained significantly different from lines of agreement, when the group was divided into fast (≥0.44 m/s) and slow walkers (<0.44 m/s). Significant differences between 6MWT and 10MWT gait speeds were observed across SCI-FAI walking mobility categories (Wilcoxon sign rank test p<.001), and mean speed thresholds for limited community ambulation differed for each measure. The smallest real difference for the 6MWT and 10MWT, as well as the minimally clinically important difference (MCID) values, were also distinct for the two tests. Conclusions While the speeds were correlated between the 6MWT and 10MWT, redundancy in the tests using predictive modeling was not observed. Different speed thresholds and separate MCIDs were defined for community ambulation for each test.
Do muscle strengthening exercises improve performance in the 6-minute walk test in postmenopausal women?
Reis, Júlia G.;Costa, Gustavo C.;Schmidt, André;Ferreira, Cristine H. J.;Abreu, Daniela C. C.;
Brazilian Journal of Physical Therapy , 2012, DOI: 10.1590/S1413-35552012005000022
Abstract: background: walking speed seems to be related to aerobic capacity, lower limb strength, and functional mobility, however it is not clear whether there is a direct relationship between improvement in muscle strength and gait performance in early postmenopausal women. objective: to evaluate the effect of muscle strengthening exercises on the performance of the 6-minute walk test in women within 5 years of menopause. methods: the women were randomized into control group (n=31), which performed no exercise, and exercise group (n=27), which performed muscle strengthening exercises. the exercises were performed twice a week for 3 months. the exercise protocol consisted of warm-up, stretching, and strengthening of the quadriceps, hamstring, calf, tibialis anterior, gluteus maximus, and abdominal muscles, followed by relaxation. muscular strength training started with 60% of 1mr (2 series of 10-15 repetitions), reaching 85% until the end of the 3-month period (4 series of 6 repetitions each). results: the between-group comparisons pre- and post-intervention did not show any difference in distance walked, heart rate or blood pressure (p>0.05), but showed differences in muscle strength post-intervention, with the exercise group showing greater strength (p conclusion: the results suggest that muscle strengthening of the lower limbs did not improve performance in the 6-minute walk test in this population of postmenopausal women.
The Importance of the 6 Minute Walk test in the assessment of Romanian teenagers with cystic fibrosis  [PDF]
Ornela O. Cluci,Bogdan Alm?jan-Gu??,Claudiu Avram,Alexandra M. Rusu
Timisoara Physical Education and Rehabilitation Journal , 2012,
Abstract: The measurement of lung function is the central part of the patients with cystic fibrosis assessment but we consider that exercise testing become an important tool in the continuous evaluation which is an indicative of prognosis and functional capacity and care of these patients. The 6 minute walk test is used to assess the individual’s response to exercise. The aim of the study is to design an exercise training program, based on 6 minute walk test and to evaluate the effects of this complex protocol including incentive therapy, individualized supervised training program: swimming, trampoline, walking, jogging, aerobic gymnastic, cycling 3 times per week and airway clearance techniques. Material and method: We conducted a 6-month study, on 20 patients from the Romanian National Cystic Fibrosis Center, aged between 12 and 18. The inclusion criteria were: FEV1 or FVC lower than 60% of predicted, SpO2 lower than 94% at rest. Results and discussions: The initial assessment showed limitations of exercise due to poor skeletal muscle mass, pulmonary status and respiratory muscle strength. After combining airway clearance techniques, incentive therapy and individualized physical training, we observed improvements regarding pulmonary function, ease of breathing and significant increased of fitness (6 minutes walking distance increased from 518.2±108.9 meters to 604.9±68 meters). A positive correlation was observed between skeletal muscle mass and distance achieved to 6 minute walk test, at the end of the study. Conclusion: The proposed rehabilitation protocol of young cystic fibrosis patients is efficient and creates pleasure and joy during physiotherapy which enhanced the patient’s adherence to the program.
Effect of wearing a dorsiflexion assist orthosis on mobility, perceived fatigue and exertion during the six-minute walk test in people with multiple sclerosis: a randomised cross-over protocol
James V McLoughlin, Christopher J Barr, Daina Sturnieks, Stephen R Lord, Maria Crotty
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-27
Abstract: A randomised cross-over trial will be conducted with 40 community dwelling PWMS with mild to moderate mobility disability. Participants will initially be screened for disease severity, balance, strength, depression and fatigue at the South Australian Motion Analysis Centre. On two non-consecutive occasions, within two weeks, participants will undergo either the 6-minute walk test (6MWT) or the 6MWT while wearing a dorsiflexion ankle orthosis (with a randomised condition order). Distance walked, perceived exertion, perceived fatigue and the physiological cost of walking (the primary outcome measures) will be compared between the two walking conditions. Additional pre- and post-6MWT assessments for the two conditions will include tests of strength, reaction time, gait and balance.This study will increase our understanding of motor fatigue on gait and balance control in PWMS and elucidate the effect of a Dynamic Ankle Orthosis on fatigue-related balance and gait in PWMS. It will also examine relationships between mobility and balance performance with perceived fatigue levels in this group.ACTRN12612000218897
Decreased Gait and Function in Duchenne Muscular Dystrophy  [PDF]
Cristina Cristina Iwabe-Marchese, Aline Fávaro, Lívia Cocato Luiz
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.23017
Abstract: Duchenne muscular dystrophy (DMD) is a genetic disorder linked to chromosome Xp21, due to absence of dystrophin production. It is clinically characterized by progressive muscle weakness, fatigue, and development of joint contractures that compromise general motor functionality, mainly the gait. Objective: To characterize the motor function and decrease gait in children with DMD using the Portuguese version of the Motor Function Measure scale (MFM-P). Methods: A review of medical records including chronological age and scores from MFM-P of children with a DMD who attended at the Neuromuscular Diseases Clinic at Campinas State University (UNICAMP), Brazil was performed in this study. A total of 36 medical records of male patients with confirmed clinical diagnosis of DMD, ambulatory or not, regardless of age; excluding those with other associated diseases or other types of muscular dystrophies were selected. Data were analyzed using Kolmogorov-Smirnov and Spearman correlation statistical tests. Results: Analysis of all data collected showed that 75% of our sample had D1 scores lower than 41.02%. There was a linear relationship between the scores of D2 and D3, but no association between D2 and D1 scores was noted. D1 score was between 40% and 80% in those patients presenting D2 scores between 80% and 100%. In all cases patients with low total score presented a greater risk for loss of gait and their functionality. Conclusion: The standing posture and the postural transfers were the worst activities observed in children with DMD, with positive correlation between proximal and distal motor function. Even with high scores according MFM-P in proximal function, the children showed strong predictors for loss of gait.
Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis  [cached]
Benedetti Maria,Agostini Valentina,Knaflitz Marco,Gasparroni Verusca
Journal of NeuroEngineering and Rehabilitation , 2012, DOI: 10.1186/1743-0003-9-64
Abstract: Background Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. However, in the literature there are only a few papers that address this disorder. The aim of this study is to identify objectively subclinical abnormal gait strategies in these patients. Methods Eleven patients affected by self-reported unsteadiness during gait (4 TBI and 7 MS) and ten healthy subjects underwent gait analysis while walking back and forth on a 15-m long corridor. Time-distance parameters, ankle sagittal motion, and muscular activity during gait were acquired by a wearable gait analysis system (Step32, DemItalia, Italy) on a high number of successive strides in the same walk and statistically processed. Both self-selected gait speed and high speed were tested under relatively unconstrained conditions. Non-parametric statistical analysis (Mann–Whitney, Wilcoxon tests) was carried out on the means of the data of the two examined groups. Results The main findings, with data adjusted for velocity of progression, show that increased double support and reduced velocity of progression are the main parameters to discriminate patients with self-reported unsteadiness from healthy controls. Muscular intervals of activation showed a significant increase in the activity duration of the Rectus Femoris and Tibialis Anterior in patients with respect to the control group at high speed. Conclusions Patients with a subjective sensation of instability, not clinically documented, walk with altered strategies, especially at high gait speed. This is thought to depend on the mechanisms of postural control and coordination. The gait anomalies detected might explain the symptoms reported by the patients and allow for a more focused treatment design. The wearable gait analysis system used for long distance statistical walking assessment was able to detect subtle differences in functional performance monitoring, otherwise not detectable by common clinical examinations.
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