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Evaluation of adaptive gait capabilities should be included in falls risk assessment
ESMAC Abstracts 2015 / Gait & Posture 42S (2015) S1–S101
Session OS02 Rehab Adults
Session OS02 Rehab Adults
Evaluation of adaptive gait capabilities should be included in falls risk assessment
The energy cost of walking in stroke survivors: (How) does holding a handrail work?
S. Egan ∗ , A. Cahill, F. Daly, J. Gilsenan, R. Keating, D. McGrath
T. Ijmker 1,∗ , C. Lamoth 2 , H. Houdijk 1 , D. Rijntjes 3 , M. Tolsma 3 , L. van der Woude 2 , A. Daffertshofer 1 , P. Beek 1
University College Dublin, Dublin, Ireland Research question: Can measures of adaptive gait add anything new to traditional functional assessments? Introduction: Adaptive gait is defined as the ability to alter gait in relation to the demands of an individuals’ environment. It is an important aspect of locomotion to consider in older adults, as adaptive gait facilitates the maintenance of functionality, independence and preventing falls [1]. However, adaptive capacity is rarely included in investigations of functional performance in older adults. Previous investigations focus on measures such as the timed-up-and-go test (TUG), the 5-times sit-to-stand (5StS) and gait speed. These tests are valid measures of physical function, but are not representative of the dynamic activities of daily life. We designed a short obstacle course to investigate whether testing adaptive locomotion could enhance standard functional assessments. Materials and methods: Twelve healthy older adults (72.40 ± 4.83 yrs, 165.7 ± 9.2 cm, 74.5 ± 10.9 kg) and 22 young healthy adults (21.4 ± 1.9 yrs, 176.2 ± 8.2 cm, 71.7 ± 11.4 kg) were recruited. TUG scores, preferred treadmill walking speed (PWS), and 5StS were recorded for each subject, along with general self-efficacy (GSE), Falls Efficacy Scale International (FES-I), Pearlin and Schoolers Mastery Scale to measure affective domains, and the Trail Making Test Part B (TMTb) to measure cognitive flexibility (CF). The obstacle course was 10 m long and required the participants to navigate between 4 foam bollards, cross two 22.86 cm hurdles, an aerobic step and a pebble filled sheet. Time taken to complete the course was recorded (OBST). A correlation matrix was generated, reporting Pearson’s r for each pair of variables. Results: The functional tasks (OBST, TUG, 5StS, PWS) were correlated r = 0.57. Age correlated with OBST (r = 0.66) and TUG (r = 0.81). A moderate correlation existed between OBST and the FES-I (r = 0.51), with a weaker relationship between TUG and FESI (r = 0.41). Conversely, TUG revealed a stronger relationship with CF (r = 0.52) than was observed for OBST (r = 0.38) GSE showed no correlation with any of the aforementioned domains. Discussion: This study explored adaptive gait with respect to more traditional measures of physical function, CF and affective domains. Performance on an “adaptive gait” based obstacle course demonstrated a stronger relationship to fear of falling than PWS, 5StS and TUG. Fear of falling is a significant risk factor in predicting future falls [2]. These results show that a 10m obstacle course could be an inexpensive and salient test in evaluating the efficacy of falls prevention programs for improving adaptive gait and reducing fall risk in older adults. References [1] Nankaku M, et al. Evaluation of hip fracture risk in relation to fall direction. Osteoporos Int 2005;16(11):1315–20. [2] Greenberg SA. Assessment of fear of falling in older adults: the falls efficacy scale-international (FES-I). Disabil Rehabil 2011;29(2):155–62.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.017
S5
1 MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, Amsterdam, Netherlands 2 Center for Human Movement Sciences, University Medical Center Groningen, Groningen, Netherlands 3 Heliomare Rehabilitation, Wijk aan Zee, Netherlands
Research question: We aimed to investigate the effect of physical support (through handrail hold) and/or somatosensory input (through light touch contact with a handrail) on energy cost and accompanying changes in step parameters and neuromuscular activity during walking in stroke survivors. Introduction: Holding a handrail or using a cane can substantially reduce the energy cost of walking in stroke survivors [1]. The underlying mechanism however remains unknown, both in terms of which aspects of handrail hold are essential for its effect (i.e. physical support or enhanced sensory information) and which gait changes mediate the improved gait economy. Understanding the nature of the energy cost reduction is essential for understanding gait recovery and gait economy post stroke. Materials and methods: Fifteen stroke survivors walked on a treadmill under three conditions: no handrail contact, light touch contact with the handrail, and firm handrail hold. During these trials oxygen consumption, center of pressure profiles under the feet, and bilateral activity of eight lower limb muscles were recorded. From this we calculated the energy cost of walking (J kg−1 m−1 ), step parameters (step time, length and width, their within trial variability, and symmetry), and the magnitude and timing constancy of muscle activation patterns (using principal component analysis). Condition effects were assessed using repeated measures ANOVA’s. To examine associations between differences in energy cost and step parameters/muscle activity, we further employed a partial least squares regression analysis. Results: Handrail hold, but not light touch contact alone, resulted in a reduction in the energy cost of walking of ∼12% on average. When holding the handrail subjects took longer steps with improved step length symmetry and smaller step width. Analysis of the EMG data showed a global drop in muscle activity, with a more constant muscle activation timing, and decreased co-activation with handrail hold. Light touch contact with a handrail did not lead to gait changes, with the exception of a small decrease in step width. The regression analysis revealed that increased stride time and length, improved step length symmetry, and decreased muscle activity were most closely associated with the decreased energy cost during handrail hold. Discussion: Handrail hold, but not light touch, altered step parameters accompanied by a reduction in muscle activity, with major neuromuscular reorganization. This suggests that the physical (and somatosensory) support from a handrail allows for a more economic step pattern that requires less muscular activation without resulting in substantial neuromuscular re-organization. Handrail use may thus have direct beneficial effects on gait
Session OS02 Rehab Adults
Session OS02 Rehab Adults
Evaluation of adaptive gait capabilities should be included in falls risk assessment
The energy cost of walking in stroke survivors: (How) does holding a handrail work?
S. Egan ∗ , A. Cahill, F. Daly, J. Gilsenan, R. Keating, D. McGrath
T. Ijmker 1,∗ , C. Lamoth 2 , H. Houdijk 1 , D. Rijntjes 3 , M. Tolsma 3 , L. van der Woude 2 , A. Daffertshofer 1 , P. Beek 1
University College Dublin, Dublin, Ireland Research question: Can measures of adaptive gait add anything new to traditional functional assessments? Introduction: Adaptive gait is defined as the ability to alter gait in relation to the demands of an individuals’ environment. It is an important aspect of locomotion to consider in older adults, as adaptive gait facilitates the maintenance of functionality, independence and preventing falls [1]. However, adaptive capacity is rarely included in investigations of functional performance in older adults. Previous investigations focus on measures such as the timed-up-and-go test (TUG), the 5-times sit-to-stand (5StS) and gait speed. These tests are valid measures of physical function, but are not representative of the dynamic activities of daily life. We designed a short obstacle course to investigate whether testing adaptive locomotion could enhance standard functional assessments. Materials and methods: Twelve healthy older adults (72.40 ± 4.83 yrs, 165.7 ± 9.2 cm, 74.5 ± 10.9 kg) and 22 young healthy adults (21.4 ± 1.9 yrs, 176.2 ± 8.2 cm, 71.7 ± 11.4 kg) were recruited. TUG scores, preferred treadmill walking speed (PWS), and 5StS were recorded for each subject, along with general self-efficacy (GSE), Falls Efficacy Scale International (FES-I), Pearlin and Schoolers Mastery Scale to measure affective domains, and the Trail Making Test Part B (TMTb) to measure cognitive flexibility (CF). The obstacle course was 10 m long and required the participants to navigate between 4 foam bollards, cross two 22.86 cm hurdles, an aerobic step and a pebble filled sheet. Time taken to complete the course was recorded (OBST). A correlation matrix was generated, reporting Pearson’s r for each pair of variables. Results: The functional tasks (OBST, TUG, 5StS, PWS) were correlated r = 0.57. Age correlated with OBST (r = 0.66) and TUG (r = 0.81). A moderate correlation existed between OBST and the FES-I (r = 0.51), with a weaker relationship between TUG and FESI (r = 0.41). Conversely, TUG revealed a stronger relationship with CF (r = 0.52) than was observed for OBST (r = 0.38) GSE showed no correlation with any of the aforementioned domains. Discussion: This study explored adaptive gait with respect to more traditional measures of physical function, CF and affective domains. Performance on an “adaptive gait” based obstacle course demonstrated a stronger relationship to fear of falling than PWS, 5StS and TUG. Fear of falling is a significant risk factor in predicting future falls [2]. These results show that a 10m obstacle course could be an inexpensive and salient test in evaluating the efficacy of falls prevention programs for improving adaptive gait and reducing fall risk in older adults. References [1] Nankaku M, et al. Evaluation of hip fracture risk in relation to fall direction. Osteoporos Int 2005;16(11):1315–20. [2] Greenberg SA. Assessment of fear of falling in older adults: the falls efficacy scale-international (FES-I). Disabil Rehabil 2011;29(2):155–62.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.017
S5
1 MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, Amsterdam, Netherlands 2 Center for Human Movement Sciences, University Medical Center Groningen, Groningen, Netherlands 3 Heliomare Rehabilitation, Wijk aan Zee, Netherlands
Research question: We aimed to investigate the effect of physical support (through handrail hold) and/or somatosensory input (through light touch contact with a handrail) on energy cost and accompanying changes in step parameters and neuromuscular activity during walking in stroke survivors. Introduction: Holding a handrail or using a cane can substantially reduce the energy cost of walking in stroke survivors [1]. The underlying mechanism however remains unknown, both in terms of which aspects of handrail hold are essential for its effect (i.e. physical support or enhanced sensory information) and which gait changes mediate the improved gait economy. Understanding the nature of the energy cost reduction is essential for understanding gait recovery and gait economy post stroke. Materials and methods: Fifteen stroke survivors walked on a treadmill under three conditions: no handrail contact, light touch contact with the handrail, and firm handrail hold. During these trials oxygen consumption, center of pressure profiles under the feet, and bilateral activity of eight lower limb muscles were recorded. From this we calculated the energy cost of walking (J kg−1 m−1 ), step parameters (step time, length and width, their within trial variability, and symmetry), and the magnitude and timing constancy of muscle activation patterns (using principal component analysis). Condition effects were assessed using repeated measures ANOVA’s. To examine associations between differences in energy cost and step parameters/muscle activity, we further employed a partial least squares regression analysis. Results: Handrail hold, but not light touch contact alone, resulted in a reduction in the energy cost of walking of ∼12% on average. When holding the handrail subjects took longer steps with improved step length symmetry and smaller step width. Analysis of the EMG data showed a global drop in muscle activity, with a more constant muscle activation timing, and decreased co-activation with handrail hold. Light touch contact with a handrail did not lead to gait changes, with the exception of a small decrease in step width. The regression analysis revealed that increased stride time and length, improved step length symmetry, and decreased muscle activity were most closely associated with the decreased energy cost during handrail hold. Discussion: Handrail hold, but not light touch, altered step parameters accompanied by a reduction in muscle activity, with major neuromuscular reorganization. This suggests that the physical (and somatosensory) support from a handrail allows for a more economic step pattern that requires less muscular activation without resulting in substantial neuromuscular re-organization. Handrail use may thus have direct beneficial effects on gait