Browsing by Subject "gait"

Now showing 1 - 4 of 4
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    Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation
    (Elsevier, 2020-11) Moore, Jennifer L.; Virva, Roberta; Henderson, Chris; Lenca, Lauren; Butzer, John F.; Lovell, Linda; Roth, Elliot; Graham, Ian D.; Hornby, T. George; Physical Medicine and Rehabilitation, School of Medicine
    Objectives The overall objectives of this project were to implement and sustain use of a gait assessment battery (GAB) that included the Berg Balance Scale, 10-meter walk test, and 6-minute walk test during inpatient stroke rehabilitation. The study objective was to assess the effect of the study intervention on clinician adherence to the recommendations and its effect on clinician perceptions and the organization. Design Pre- and post-training intervention study. Setting Subacute inpatient rehabilitation facility. Participants Physical therapists (N=6) and physical therapist assistants (N=2). Intervention The intervention comprised a bundle of activities, including codeveloping and executing the plan with clinicians and leaders. The multicomponent implementation plan was based on the Knowledge-to-Action Framework and included implementation facilitation, implementation leadership, and a bundle of knowledge translation interventions that targeted barriers. Implementation was an iterative process in which results from one implementation phase informed planning of the next phase. Main Outcome Measures Clinician administration adherence, surveys of perceptions, and organizational outcomes. Results Initial adherence to the GAB was 46% and increased to more than 85% after 6 months. These adherence levels remained consistent 48 months after implementation. Clinician perceptions of measure use were initially high (>63%), with significant improvements in knowledge and use of one measure after implementation. Conclusions We successfully implemented the assessment battery with high levels of adherence to recommendations, likely because of using the bundle of knowledge translation activities, facilitation, and use of a framework to codevelop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.
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    Locomotor Kinematics and Kinetics Following High-Intensity Stepping Training in Variable Contexts Poststroke
    (SAGE, 2020-06-06) Ardestani, Marzieh M.; Henderson, Christopher E.; Mahtani, Gordhan; Connolly, Mark; Hornby, T. George; Physical Medicine and Rehabilitation, School of Medicine
    Background and Purpose Previous studies suggest individuals post-stroke can achieve substantial gains in walking function following high-intensity locomotor training (LT). Recent findings also indicate practice of variable stepping tasks targeting locomotor deficits can mitigate selected impairments underlying reduced walking speeds. The goal of this study was to investigate alterations in locomotor biomechanics following three different LT paradigms. Methods This secondary analysis of a randomized trial recruited individuals 18–85 years old and >6 months post-stroke. We compared changes in spatiotemporal, joint kinematics and kinetics following up to 30 sessions of high-intensity (>70% heart rate reserve [HRR]) LT of variable tasks targeting paretic limb and balance impairments (high-variable, HV), high-intensity LT focused only on forward walking (high-forward, HF), or low-intensity LT (<40% HRR) of variable tasks (low-variable, LV). Sagittal spatiotemporal and joint kinematics, and concentric joint powers were compared between groups. Regressions and principle component (PC) analyses were conducted to evaluate relative contributions or importance of biomechanical changes to between and within groups. Results Biomechanical data were available on 50 participants who could walk ≥0.1 m/s on a motorized treadmill. Significant differences in spatiotemporal parameters, kinematic consistency, and kinetics were observed between HV and HF vs LV. Resultant PC analyses were characterized by paretic powers and kinematic consistency following HV, while HF and LV were characterized by non-paretic powers. Conclusion High-intensity LT results in greater changes in kinematics and kinetics as compared to lower-intensity interventions. The results may suggest greater paretic-limb contributions with high-intensity variable stepping training that targets specific biomechanical deficits.
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    The Need for Speed in Rodent Locomotion Analyses.
    (Wiley, 2014-10) Batka, Richard J.; Brown, Todd J.; Mcmillan, Kathryn P.; Meadows, Rena M.; Jones, Kathryn J.; Haulcomb, Melissa M.; Department of Anatomy & Cell Biology, IU School of Medicine
    Locomotion analysis is now widely used across many animal species to understand the motor defects in disease, functional recovery following neural injury, and the effectiveness of various treatments. More recently, rodent locomotion analysis has become an increasingly popular method in a diverse range of research. Speed is an inseparable aspect of locomotion that is still not fully understood, and its effects are often not properly incorporated while analyzing data. In this hybrid manuscript, we accomplish three things: (1) review the interaction between speed and locomotion variables in rodent studies, (2) comprehensively analyze the relationship between speed and 162 locomotion variables in a group of 16 wild-type mice using the CatWalk gait analysis system, and (3) develop and test a statistical method in which locomotion variables are analyzed and reported in the context of speed. Notable results include the following: (1) over 90% of variables, reported by CatWalk, were dependent on speed with an average R2 value of 0.624, (2) most variables were related to speed in a nonlinear manner, (3) current methods of controlling for speed are insufficient, and (4) the linear mixed model is an appropriate and effective statistical method for locomotion analyses that is inclusive of speed-dependent relationships. Given the pervasive dependency of locomotion variables on speed, we maintain that valid conclusions from locomotion analyses cannot be made unless they are analyzed and reported within the context of speed.
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    Task-Specific Versus Impairment-Based Training on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study
    (SAGE, 2020-06-01) Lotter, Jennifer K.; Henderson, Christopher E.; Plawecki, Abbey; Holthus, Molly E.; Lucas, Emily H.; Ardestani, Marzieh M.; Schmit, Brian D.; Hornby, T. George; Physical Medicine and Rehabilitation, School of Medicine
    Background: Many research studies attempting to improve locomotor function following motor incomplete spinal cord injury (iSCI) focus on providing stepping practice. However, observational studies of physical therapy strategies suggest the amount of stepping practice during clinical rehabilitation is limited; rather, many interventions focus on mitigating impairments underlying walking dysfunction. Objective: The purpose of this blinded-assessor randomized trial was to evaluate the effects of task-specific vs impairment-based interventions on walking outcomes in individuals with iSCI. Methods: Using a crossover design, ambulatory participants with iSCI > 1-year duration performed either task-specific (upright stepping) or impairment-based training for up to 20 sessions over ≤6 weeks, with interventions alternated after >4 weeks delay. Both strategies focused on achieving higher cardiovascular intensities, with training specificity manipulated by practicing only stepping practice in variable contexts or practicing impairment-based tasks targeting impairments underlying locomotor dysfunction (strengthening, balance tasks, and recumbent stepping). Results: Significantly greater increases in fastest overground and treadmill walking speeds were observed following task-specific vs impairment-based training, with moderate associations between differences in amount of practice and outcomes. Gains in balance confidence were also observed following task-specific vs impairment-based training, although incidence of falls was also increased with the former protocol. Limited gains were observed with impairment-based training except for peak power during recumbent stepping tests. Conclusion: The present study reinforces work from other patient populations that the specificity of task practice is a critical determinant of locomotor outcomes and suggest impairment-based exercises may not translate to improvements in functional tasks.