- Email: [email protected]
Physiotherapeutic group training to improve gait in diabetic patients: A randomized controlled trial
S2
Abstracts / Gait & Posture 30S (2009) S1–S153
(12 DRFT, 10 non-DRFT), 12 atypical (7 DRFT, 5 non-DRFT) and 20 crouch pattern (6 DRFT, 14 Non-DRFT). The E1 was done in 6 DRFTpatients and 4 non-DRFT patients. Out of the latter only 1 received a secondary DRFT.
significant between group difference (p ≤ 0.05) was found for all measured gait variables except for the coefficient of variation of gait cycle time. Differences remained significant at the 6-month follow-up.
Discussion Due to the complexity of gait disturbances in spastic diplegia and the combination of different surgical procedures in SEMLS, the effects of DRFT cannot be evaluated sufficiently by retrospective analysis. The recent study is the first randomized trial, which validates the necessity of additional DRFT. The first results seem to underline the doubts for the effect after DRFT, since not all non-DRFT patients needed a secondary procedure according to the functional outcome 1-year postoperativley. The purpose of this study is to redefine indication criteria for the DRFT and to spare the patients unnecessary surgery in the future.
Conclusions Specific training can improve diabetic patients’ gait. Further studies are needed to explore these improvements’ influence on the number of reported falls, patients’ physical activity level and quality of life.
References [1] [2] [3] [4]
Dreher T, et al. Gait Posture 2007;26:S48–9. Delp SL, et al. J Biomech 27:1201–11. Asakawa DS, et al. J Bone Joint Surg 2004;86:348–54. Scott NW, et al. Controlled Clin Trials 2002;23:662–74.
doi:10.1016/j.gaitpost.2009.08.005 O2 Physiotherapeutic group training to improve gait in diabetic patients: A randomized controlled trial Lara Allet 2,∗ , Stephan Armand 1 , Rob deBie 2 , Kamiar Aminian 3 , Zoltan Pataky 1 , Alain Golay 1 , Eling deBruin 4 1
University Hospital and University Geneva, Geneva, Switzerland Maastricht University and Caphri Research School, Maastricht, Netherlands 3 Laboratory of Movement Analysis and Measurement, EPFL, Lausanne, Switzerland 4 Institute of Human Movement Sciences and Sport, ETH, Zürich, Switzerland 2
Summary We present results from a randomized controlled study evaluating the effect of a specific training program, on diabetic patients’ gait. The intervention consisted of physiotherapeutic group training with gait and balance exercises combined with function-orientated strengthening, twice a week during 12 weeks. After intervention a
Fig. 1.
Introduction Diabetic patients tend to walk slower, present decreased cadence, shorter stride length, increased stance and higher stepto-step variability than age matched healthy controls [1]. Little is known about possible treatments. Patients/methods/material Seventy-one patients with type 2 diabetes and neuropathy (vibration threshold ≤4/8) were included: 35 were allocated to the intervention group (IG) and 36 to the control group (CG). Exclusion criteria were: medical contraindication for physical activity, foot ulcers, orthopaedic problems, non-diabetic neuropathy, or incapacity to walk without a walking aid for a minimum of 500 m. The intervention consisted of physiotherapeutic group training with gait and balance exercises combined with function-orientated strengthening, twice a week during 12 weeks. Controls received no treatment. Spatio-temporal parameters (velocity, cadence, gait cycle time and stance phase) were measured with an ambulatory measurement system Physilog® (BioAGM, CH) [2] at baseline, post intervention (PI) and 6 months follow-up (6FU) on a tarred and cobbled-stoned pathway. Each outcome was analyzed by linear regression (i.e. analysis of covariance) using SPSS. Results IG participants increased heir speed of 0.15 m/s at PI (p < 0.05). A significant between group difference (p ≤ 0.05) was also found for all other measured variables except for the coefficient of variation of gait cycle time (CVGCT) (p = 0.99 for tar and 0.16 for stones) (Fig. 1). IG participants partially lost their treatment benefits during the 6FU, but their levels remained superior to that at baseline. All parameters in the CG progressively deteriorated. Discussion Specific physiotherapeutic training improved diabetic patients’ gait. The speed increase of 0.15 m/s at PI is clinically relevant (a decrease in gait speed of 0.1 m/s in the elderly has been associated
Abstracts / Gait & Posture 30S (2009) S1–S153
with a 10% decrease in the ability to perform ADL activities [3]). The absence of improvement for the CVGCT could be due to relatively low baseline values and consequently small improvement. Further studies should evaluate the program’s influence on fall frequency, physical activity level, and quality of life.
References [1] Allet L, et al. Gait Posture 2009;29(3). [2] Aminian K, et al. J Biomech 2002;35(5). [3] Lopopolo RB, et al. Phys Ther 2006;86(4).
doi:10.1016/j.gaitpost.2009.08.006
S3
between the shoulder muscle torque and the elbow interaction torque increased with the training (F(1,6) = 0.54, p = 0.05). Discussion The training protocol used was efficient to increase muscle strength and this gain was transferred to improve motor performance in terms of movement speed. This increase in speed of the arm in the direction of the target was achieved with an increase in the quantity (impulse) of shoulder and elbow muscle torques and the elbow interaction torque, generated during the acceleration of the arm to target. However, the increase in speed of the arm back to the initial position was achieved by improving the linear coupling between the shoulder muscle torque and elbow interaction muscle torque.
O3 Effect of weight training protocol on the motor control strategies used by individuals with Down syndrome Nadia
Marconi ∗ ,
References [1] Almeida GL, Hasan Z, Corcos DM. J Neurophysiol 2000;84:1949–60. [2] Shields N, Dodd K. Phys Ther 2004;9:109–15.
Irlei Santos, Claudia Oliveira, Joao Corrêa
Nove de Julho university, Sao Paulo, Sao Paulo, Brazil
doi:10.1016/j.gaitpost.2009.08.007
Summary We tested the hypothesis that individuals with Down syndrome (DS) would be able to increase the strength of arm muscles after taking part in a weight training protocol. This increase in strength would be reflected in a better motor performance during upper arm movements with reversal.
O4
Conclusions Individuals DS increased muscle strength and were able to transfer this increment in strength to improve the motor performance during the voluntary movements. Thus, the weight training protocol showed to be a great training strategy to help these individuals.
Karlinska Institutet, Stockhlm, Sweden
Introduction During the performance of upper arm movements with reversal, individuals DS are slow and clumsy [1]. After practice of these movements, these individuals were unable to increase the shoulder muscle torque and elbow interaction torque to move faster. Several studies have reported the deficit in the capacity to generate muscle strength in individuals DS [2] and this behavior can explain the difficulty presented by this group to increase the torques generated at joints even after practice. Patients/materials and methods Eight volunteers took part a weight training protocol with progressive resistance for the upper arms with dumbbells. The training was done three times a week, during 4 weeks. The upper arm movements with reversal were analyzed before and after the training period using Optotrak 3020. The muscle and interaction torques of shoulder and elbow joints were calculated using the Inverse dynamics. For analysis proposal the movements were divided into four different phases. Results A t-test between the first and the final session revealed a significant increase in the weight lifting for all group of muscles tested. Individuals DS were able to use the increase in muscle strength to move faster from initial position to the target (F(1,6) = 20.92, p = 0.00) and from target backing to initial position (F(1,6) = 34.12, p = 0.00). The results of ANOVA revealed increase for the shoulder and elbow muscle torque with the training during the first movement phase (F(1,6) > 5.73, p < 0.05). The results of the ANOVA for the shoulder and elbow interaction torque did not reveal any effect of the training (F(1,6) > 0.52, p > 0.05), except in the first phase to elbow interaction torque (F(1,6) = 5.11, p < 0.05). Also, the linear coupling
The effect of TNF-␣-inhibitors on gait patterns in patients with inflammatory diseases Anna-Clara Broström
Esbjörnsson ∗ , Per
Wretenberg, Per
Larsson, Eva
Summary The purpose of this pilot study was to investigate changes in gait patterns in patients with inflammatory diseases after treatment with TNF-␣-inhibitors. These preliminary results suggest that TNF-␣-inhibitors improve spatio-temporal parameters. Minor improvements were seen in joint kinematics. No significant improvements were seen in joint moments, power or work. Clinical measures of disease activity and were significantly improved. Conclusion Treatment with TNF-␣-inhibitors has an impact on spatiotemporal parameters and clinical measures in patients with inflammatory diseases. Introduction Biologic drugs which inhibit Tumour Necrosis Factor-alpha (TNF-␣) have been shown to induce sustained improvement of inflammatory symptoms in patients with inflammatory diseases [1]. Adults with inflammatory disease often show deviations from normal gait and this is a significant problem for the individual [2]. Therefore, the purpose of this study was to investigate changes in gait patterns in this category of patients after treatment with TNF␣-inhibitors. Patients/material and methods Ten women and three men with inflammatory diseases (mean 58 ± 12 yrs) participated. All patients had a history of lower limb involvement and were about to start treatment with TNF␣-inhibitors. Three-dimensional upper and lower extremity joint kinematics, joint kinetics and spatio-temporal data of independent barefoot walking were collected 0–7 days prior to treatment onset and 3-month follow-up. Health Assessments Questionnaire (HAQ) was completed at both evaluations as well as Disease Activity Score (DAS 28), general health and pain. Results Three months after treatment with TNF-␣-inhibitors the following clinical measures improved; HAQ (p = 0.05), DAS 28 (p = 0.01),
Abstracts / Gait & Posture 30S (2009) S1–S153
(12 DRFT, 10 non-DRFT), 12 atypical (7 DRFT, 5 non-DRFT) and 20 crouch pattern (6 DRFT, 14 Non-DRFT). The E1 was done in 6 DRFTpatients and 4 non-DRFT patients. Out of the latter only 1 received a secondary DRFT.
significant between group difference (p ≤ 0.05) was found for all measured gait variables except for the coefficient of variation of gait cycle time. Differences remained significant at the 6-month follow-up.
Discussion Due to the complexity of gait disturbances in spastic diplegia and the combination of different surgical procedures in SEMLS, the effects of DRFT cannot be evaluated sufficiently by retrospective analysis. The recent study is the first randomized trial, which validates the necessity of additional DRFT. The first results seem to underline the doubts for the effect after DRFT, since not all non-DRFT patients needed a secondary procedure according to the functional outcome 1-year postoperativley. The purpose of this study is to redefine indication criteria for the DRFT and to spare the patients unnecessary surgery in the future.
Conclusions Specific training can improve diabetic patients’ gait. Further studies are needed to explore these improvements’ influence on the number of reported falls, patients’ physical activity level and quality of life.
References [1] [2] [3] [4]
Dreher T, et al. Gait Posture 2007;26:S48–9. Delp SL, et al. J Biomech 27:1201–11. Asakawa DS, et al. J Bone Joint Surg 2004;86:348–54. Scott NW, et al. Controlled Clin Trials 2002;23:662–74.
doi:10.1016/j.gaitpost.2009.08.005 O2 Physiotherapeutic group training to improve gait in diabetic patients: A randomized controlled trial Lara Allet 2,∗ , Stephan Armand 1 , Rob deBie 2 , Kamiar Aminian 3 , Zoltan Pataky 1 , Alain Golay 1 , Eling deBruin 4 1
University Hospital and University Geneva, Geneva, Switzerland Maastricht University and Caphri Research School, Maastricht, Netherlands 3 Laboratory of Movement Analysis and Measurement, EPFL, Lausanne, Switzerland 4 Institute of Human Movement Sciences and Sport, ETH, Zürich, Switzerland 2
Summary We present results from a randomized controlled study evaluating the effect of a specific training program, on diabetic patients’ gait. The intervention consisted of physiotherapeutic group training with gait and balance exercises combined with function-orientated strengthening, twice a week during 12 weeks. After intervention a
Fig. 1.
Introduction Diabetic patients tend to walk slower, present decreased cadence, shorter stride length, increased stance and higher stepto-step variability than age matched healthy controls [1]. Little is known about possible treatments. Patients/methods/material Seventy-one patients with type 2 diabetes and neuropathy (vibration threshold ≤4/8) were included: 35 were allocated to the intervention group (IG) and 36 to the control group (CG). Exclusion criteria were: medical contraindication for physical activity, foot ulcers, orthopaedic problems, non-diabetic neuropathy, or incapacity to walk without a walking aid for a minimum of 500 m. The intervention consisted of physiotherapeutic group training with gait and balance exercises combined with function-orientated strengthening, twice a week during 12 weeks. Controls received no treatment. Spatio-temporal parameters (velocity, cadence, gait cycle time and stance phase) were measured with an ambulatory measurement system Physilog® (BioAGM, CH) [2] at baseline, post intervention (PI) and 6 months follow-up (6FU) on a tarred and cobbled-stoned pathway. Each outcome was analyzed by linear regression (i.e. analysis of covariance) using SPSS. Results IG participants increased heir speed of 0.15 m/s at PI (p < 0.05). A significant between group difference (p ≤ 0.05) was also found for all other measured variables except for the coefficient of variation of gait cycle time (CVGCT) (p = 0.99 for tar and 0.16 for stones) (Fig. 1). IG participants partially lost their treatment benefits during the 6FU, but their levels remained superior to that at baseline. All parameters in the CG progressively deteriorated. Discussion Specific physiotherapeutic training improved diabetic patients’ gait. The speed increase of 0.15 m/s at PI is clinically relevant (a decrease in gait speed of 0.1 m/s in the elderly has been associated
Abstracts / Gait & Posture 30S (2009) S1–S153
with a 10% decrease in the ability to perform ADL activities [3]). The absence of improvement for the CVGCT could be due to relatively low baseline values and consequently small improvement. Further studies should evaluate the program’s influence on fall frequency, physical activity level, and quality of life.
References [1] Allet L, et al. Gait Posture 2009;29(3). [2] Aminian K, et al. J Biomech 2002;35(5). [3] Lopopolo RB, et al. Phys Ther 2006;86(4).
doi:10.1016/j.gaitpost.2009.08.006
S3
between the shoulder muscle torque and the elbow interaction torque increased with the training (F(1,6) = 0.54, p = 0.05). Discussion The training protocol used was efficient to increase muscle strength and this gain was transferred to improve motor performance in terms of movement speed. This increase in speed of the arm in the direction of the target was achieved with an increase in the quantity (impulse) of shoulder and elbow muscle torques and the elbow interaction torque, generated during the acceleration of the arm to target. However, the increase in speed of the arm back to the initial position was achieved by improving the linear coupling between the shoulder muscle torque and elbow interaction muscle torque.
O3 Effect of weight training protocol on the motor control strategies used by individuals with Down syndrome Nadia
Marconi ∗ ,
References [1] Almeida GL, Hasan Z, Corcos DM. J Neurophysiol 2000;84:1949–60. [2] Shields N, Dodd K. Phys Ther 2004;9:109–15.
Irlei Santos, Claudia Oliveira, Joao Corrêa
Nove de Julho university, Sao Paulo, Sao Paulo, Brazil
doi:10.1016/j.gaitpost.2009.08.007
Summary We tested the hypothesis that individuals with Down syndrome (DS) would be able to increase the strength of arm muscles after taking part in a weight training protocol. This increase in strength would be reflected in a better motor performance during upper arm movements with reversal.
O4
Conclusions Individuals DS increased muscle strength and were able to transfer this increment in strength to improve the motor performance during the voluntary movements. Thus, the weight training protocol showed to be a great training strategy to help these individuals.
Karlinska Institutet, Stockhlm, Sweden
Introduction During the performance of upper arm movements with reversal, individuals DS are slow and clumsy [1]. After practice of these movements, these individuals were unable to increase the shoulder muscle torque and elbow interaction torque to move faster. Several studies have reported the deficit in the capacity to generate muscle strength in individuals DS [2] and this behavior can explain the difficulty presented by this group to increase the torques generated at joints even after practice. Patients/materials and methods Eight volunteers took part a weight training protocol with progressive resistance for the upper arms with dumbbells. The training was done three times a week, during 4 weeks. The upper arm movements with reversal were analyzed before and after the training period using Optotrak 3020. The muscle and interaction torques of shoulder and elbow joints were calculated using the Inverse dynamics. For analysis proposal the movements were divided into four different phases. Results A t-test between the first and the final session revealed a significant increase in the weight lifting for all group of muscles tested. Individuals DS were able to use the increase in muscle strength to move faster from initial position to the target (F(1,6) = 20.92, p = 0.00) and from target backing to initial position (F(1,6) = 34.12, p = 0.00). The results of ANOVA revealed increase for the shoulder and elbow muscle torque with the training during the first movement phase (F(1,6) > 5.73, p < 0.05). The results of the ANOVA for the shoulder and elbow interaction torque did not reveal any effect of the training (F(1,6) > 0.52, p > 0.05), except in the first phase to elbow interaction torque (F(1,6) = 5.11, p < 0.05). Also, the linear coupling
The effect of TNF-␣-inhibitors on gait patterns in patients with inflammatory diseases Anna-Clara Broström
Esbjörnsson ∗ , Per
Wretenberg, Per
Larsson, Eva
Summary The purpose of this pilot study was to investigate changes in gait patterns in patients with inflammatory diseases after treatment with TNF-␣-inhibitors. These preliminary results suggest that TNF-␣-inhibitors improve spatio-temporal parameters. Minor improvements were seen in joint kinematics. No significant improvements were seen in joint moments, power or work. Clinical measures of disease activity and were significantly improved. Conclusion Treatment with TNF-␣-inhibitors has an impact on spatiotemporal parameters and clinical measures in patients with inflammatory diseases. Introduction Biologic drugs which inhibit Tumour Necrosis Factor-alpha (TNF-␣) have been shown to induce sustained improvement of inflammatory symptoms in patients with inflammatory diseases [1]. Adults with inflammatory disease often show deviations from normal gait and this is a significant problem for the individual [2]. Therefore, the purpose of this study was to investigate changes in gait patterns in this category of patients after treatment with TNF␣-inhibitors. Patients/material and methods Ten women and three men with inflammatory diseases (mean 58 ± 12 yrs) participated. All patients had a history of lower limb involvement and were about to start treatment with TNF␣-inhibitors. Three-dimensional upper and lower extremity joint kinematics, joint kinetics and spatio-temporal data of independent barefoot walking were collected 0–7 days prior to treatment onset and 3-month follow-up. Health Assessments Questionnaire (HAQ) was completed at both evaluations as well as Disease Activity Score (DAS 28), general health and pain. Results Three months after treatment with TNF-␣-inhibitors the following clinical measures improved; HAQ (p = 0.05), DAS 28 (p = 0.01),