The aim of this study was to compare sagittal plane lower limb kinematics during walking on land and submerged to the hip in water. Eight healthy adults (age 22.1 ± 1.1 years, body height 174.8 ± 7.1 cm, body mass 63.4 ± 6.2 kg) were asked to cover a distance of 10 m at comfortable speed with controlled step frequency, walking forward or backward. Sagittal plane lower limb kinematics were obtained from three dimensional video analysis to compare spatiotemporal gait parameters and joint angles at selected events using two-way repeated measures ANOVA. Key findings were a reduced walking speed, stride length, step length and a support phase in water, and step length asymmetry was higher compared to the land condition (p<0.05). At initial contact, knees and hips were more flexed during walking forward in water, whilst, ankles were more dorsiflexed during walking backward in water. At final stance, knees and ankles were more flexed during forward walking, whilst the hip was more flexed during backward walking. These results show how walking in water differs from walking on land, and provide valuable insights into the development and prescription of rehabilitation and training programs.
Purpose. The purpose of this investigation was to determine the effect of body movement on the ability of a portable telemetric gas analysis device, the Cosmed K4b2, to produce a reliable measure of walking oxygen consumption (VO2). Methods. Thirteen adults were asked to report to a laboratory for three test sessions. During Session 1, participants were familiarized with the data collection procedures and completed a 15-min treadmill accommodation. In Sessions 2 and 3, each participant completed four 5-min treadmill walking trials at 1.8 m · sec-1 under different experimental conditions while VO2 was collected using the portable system. The four conditions were used to manipulate the portable metabolic system to mimic different types of movement. Results. Data analysis revealed no significant differences (p = 0.070) amongst VO2 values across all four experimental conditions during Sessions 2 and 3. Between-day coefficients of variation for the mean VO2 values of the four conditions ranged from 2.7% to 3.8%, with the highest level of variation occurring whilst the unit was strapped to the participant’s chest. Conclusions. Viewed collectively, the Cosmed K4b2 may produce reliable measures of VO2 in adult participants during treadmill walking who exhibit little vertical oscillation. However, future research is necessary to determine if the K4b2 is a valid instrument for collecting VO2 data if excessive body movement in the vertical direction can affect the data collection instrumentation.
Balance and gait stability assessment is an important part of the otoneurological examination. We present the review of the clinical bedside tests procedures for diagnosis patients with balance disorders. Instability may occur not only in vestibular system dysfunction but in neurological, musculoskeletal and visual system lesions as well. An accurate clini-cal bedside ocular motor examination like, range of motion, stability of fixation, the presence of nystagmus, saccadic and smooth pursuit tests, give information about dynamic character of ocular motility. Tests of the balance system and cerebellum functioning were elaborated. Interpretations criteria for clinical bedside tests in different disease were pre-sented. Head shaking and head trust tests for vestibular system imbalance were described. Authors paid attention to the connection between examinations results and labyrinth or central nervous system disorders. Other tests are suggested to be used in benign paroxysmal positional vertigo diagnosis and ability to self-contained patients gait evaluation. There are some more complex and time-consuming tests like Dynamic Gait Index and Berg Balance Scale, measuring quanti-tative aspects of gait efficiency. The results are obtained based on points which are obtained in various tasks e.g. walking with pivot turn, stepping over and around obstacles. All of these tests are essential part of clinical examination and give preliminary information about patients functioning status and allow to focus on further diagnosis.The final results based on points which are obtained in various tasks e.g. walking with pivot turn, stepping over and around obstacles. All of these tests are essential part of clinical examination and give preliminary information about patients functioning status and allow to focus on further diagnosis.
Purpose. This study investigated the EMG characteristics of muscles crossing the knee and the kinetics of the lower extremity during side-slope walking and other activities of daily living. We studied the difference in EMG data of the medial gastrocnemius and vastus lateralis muscles bilaterally and the relative rotation of the thigh to leg. Methods. Eleven outdoor workers (47.3 ± 13.9 years old) were recruited for this study. Participants walked on a 0° flat surface, 5° and 10° side-sloped surfaces, 10° inclined treadmill and ascended stairs. The EMG activity and rotation about a vertical axis during stance phase were analyzed. Results. Except for minor variations, ANOVA showed no significant difference in EMG activity between the walking surfaces, furthermore, the relative rotation of thigh-to-leg showed little or no differences between the variables. Multivariate ANOVA showed p-values between 0.1602 and 0.9943 when comparing the EMG data of all side-sloped surfaces. The relative rotation of the thigh to the leg showed p-values of 0.7837 and 0.9813 when comparing the left 0° to 10° and right 0° to 10°, respectively. Conclusions. The results of this study indirectly indicate that when considering rotation about a vertical axis and EMG activity, there is little difference in knee joint loading.
Purpose. A description of gait analysis during overground locmotion has been the subject of various studies, in relation to describing both the kinetic and spatial-temporal characteristics of walking. Measuring the gait of amputees using treadmills is a useful test to quantify locomotive ability, and a tool that helps to control gait parameters during rehabilitation. The aim of this study is to describe the kinetic and spatial-temporal characteristics of gait of rehabilitated amputees, measured with an instrumented treadmill. Methods. Twenty-four participants aged between 20 and 40 years were chosen, who had all suffered unilateral traumatic amputation either above or below the knee, and were classified as well-rehabilitated. Following a paperbased assessment form, the participants were subjected to gait analysis on an instrumented treadmill fitted with two force platforms. Results. The first peak vertical force of intact and amputated limbs presented higher values and was significantly (p 0.05) larger than the second peak vertical force for the amputated limb, indicating less propulsion during walking. A significant difference was observed in the load rate in intact and amputated limbs, indicating more overload in the intact limb. The spatial-temporal variables, cadence, step and stride length were significantly greater (p 0.05) in the below-knee than in the above-knee amputees. Conclusions. The kinetic and spatial-temporal characteristics of gait, measured with an instrumented treadmill, which were observed in all lower limb amputees involved in this study, were similar to the ones commonly reported in numerous studies on overground walking. Thus, treadmill gait training and control of the progress of rehabilitation with amputees is recommended.
Purpose. The gait is the most common human movement, a functional task that requires complex and coordinated interactions of the body. This activity has been the subject of various studies, both in relation to descriptions of typical body movements as in pathological conditions and therapeutic interventions. The objective of this study was to describe and analyze the variation of peak acceleration in the tibia by means of accelerometers during the gait cadence induced in normal subjects. Basic procedures. Nine subjects walked on a catwalk on a straight line for 8 meters at 4 km/h (± 5%), 5 km/h (± 5%) and 6 km/h (± 5%) using uniaxial piezoelectric accelerometers with scale 7g set at the midpoint of both tibiae. Main findings. It was observed that there was no difference in peak acceleration between dominant and non-dominant limbs, however, there was significant difference (p <0.05) among all the velocities with which the subjects were analyzed. Conclusions. It is suggested that the variation of 1 km/h is enough to change the peak acceleration of the tibia.
The Spine Buddy® supportive pad was developed to be inserted underneath military backpacks to help disperse the heavy load of the backpack. The purpose of this study was to determine the impact the additional supportive pad had on static balance and a running gait while wearing a military backpack. Forty healthy subjects (age= 27.5 + 5.6 yrs, body height= 1.78 + 0.06 m, body mass= 86.5 + 14.0 kg: mean + SD) participated in a static single-leg balance test on a force plate with each lower limb while wearing a 15.9 kg military backpack for 30 s. Following this, participants were randomized to one of two interventions: 1) Intervention, which wore the Spine Buddy® supportive pad underneath their backpack or 2) Control, with no additional supportive pad. Post-intervention measurements of static single-leg balance were then recorded. Afterwards, a similar pre vs post testing schedule and randomization scheme was used to test the impact of the supportive pad on a 5 mph jogging gait using Vicon® cameras. Within-group data were analyzed with a 2-way repeated measures ANOVA. Statistically significant differences were not seen between the control and experimental group for balance and gait variables. Preliminarily, this suggests that the Spine Buddy® supportive pad causes no deleterious effect on static balance and a jogging gait in 18-45 year-old asymptomatic individuals.
The aim of the study was to determine the level of functional independence in adult patients with previously undiagnosed or untreated phenylketonuria (PKU). The study was conducted among 400 intellectually impaired adult residents of Social Welfare Homes in South-Eastern Poland born prior to the introduction of neonatal PKU screening programs. PKU was screened by filter paper test using tandem mass spectrometry methods, and confirmed by gas chromatography-mass spectrometric analysis of PKU organic acids in urine. Degree of functional independence included the assessment of activities of daily living (Barthel Index) and measures of balance and gait (Tinetti scale). Eleven individuals with previously untreated PKU were identified whereby eight presented with moderate disability and three with mild disability. Six had a high risk of falls and five had a moderate risk of falls. This study indicates that there is considerable number of undiagnosed PKU patients within the Polish population who require assessment and management in order to reduce the impact of the neurological and neuropsychiatric problems associated with the condition. Appropriate therapy for those with undiagnosed PKU should, in particular, address the risk of falls.
Flat foot is caused by subtalar joint hypermobility which leads to changes in foot mechanics while walking. It results in increased load of the musculoskeletal system of the foot. It is proved by the literature which presents flat foot as an etiological factor responsible for numerous overuse injuries in this region. In particular, they concern the structures which support the longitudinal arch of the foot, i.e. Achilles tendon, tendons of tibialis posterior muscle, plantar fascia, sesamoid bones, hallux, metatarsal head and metatarsal bones. Due to the fact that foot loads and mechanics change during different gait phases, the magnitude of forces affecting particular tendons and ligaments also varies at its specific phases. Therefore, it is important that the findings of the latest studies on flat foot be collected in order to develop appropriate programmes of functional rehabilitation of the indicated deformity as well as therapeutic programmes for overuse injuries. Although this deformity and its consequences are a common problem, the foot still remains an unexplored area at the level of kinematics and kinetics. In particular, it is necessary to conduct research regarding correlations between the foot structure and its functions. It will be possible to broaden the knowledge in this field owing to the development or identification of the mathematical foot model taking into account common kinesiological problems with lower limbs that stem from flat foot.
Background: Obstacles are a common cause of falls. Mobility tests for healthy elderly that involve maneuvering over an obstacle have not been fully developed. We have shown that a small box placed on the walkway of a representative mobility test, the Timed Up & Go (TUG) for the frail elderly, influences the test performances of the healthy female elderly. However, the validity of this obstructed TUG (OTUG) as a fall risk assessment tool has not yet been clarified. This study examined the relationship between the OTUG and the fall risk for the healthy elderly. Material/Methods: 66 healthy community-dwelling elderly and 19 healthy elderly persons living in a nursing home participated in the study. In the TUG, participants stood up from a chair, walked 3 m, turned around, walked back to the chair and sat down. In the OTUG, a box (height 5 cm, depth 10 cm) was placed at the midpoint of the walkway. Participants were instructed to step over it safely. Times required to perform the respective test were recorded. Fall risk scores, the required times (s) for the TUG and OTUG and difference ratios (OTUG/TUG x 100) (%) were analyzed. Results: Correlations between fall risk and other mobility performances were all significant. However, the correlation between fall risk and the OTUG (r = 0.60) was significantly higher than that between fall risk and the TUG (r=0.49) (t=3.733, p<0.001). Conclusions: Compared to the TUG, the OTUG is more valid for assessing the fall risk of community- dwelling healthy elderly
Peripheral artery disease (PAD) is associated with altered gait biomechanics. No previous research study has investigated the effect of activity on muscle activation in individuals with PAD. The purpose of this study was to investigate the effect of PAD on muscle activation in response to a ten-minute walking task. METHODS: Ten healthy young adults, ten healthy older adults and ten individuals with PAD performed a ten-minute treadmill walking trial at a self-selected velocity. Surface EMG was recorded from the vastus lateralis and medial gastrocnemius during five steps in the first and tenth minutes of the walking trial. EMG signals were rectified and smoothed using the root mean squared (RMS) with a 20 ms smoothing window. Peak RMS EMG and median frequencies (MdF) were calculated. Mixed-model ANOVAs with Tukey’s post-hoc was used to determine effects of group and activity on peak RMS EMG and MdF. RESULTS: PAD was associated with significantly greater reductions in MdF of the vastus lateralis compared to healthy young and healthy older adults. No significant differences were observed in peak RMS EMG. DISCUSSION: PAD is associated with exaggerated rates of fatigue in the quadriceps but not the gastrocnemius. Efficacy of evidence-based therapeutic interventions should be further investigated.
Wstęp: Postawa ciała, w tym ustawienie kolan, oraz nadmierna masa ciała mają wymierny wpływ na sposób poruszania się człowieka. Większość dysfunkcji somatycznych i motorycznych pojawiających się w wieku dojrzałym ma swoje podłoże w wieku dziecięcym. Pojawiające się u osób dorosłych dolegliwości narządu ruchu często są skutkiem niezauważonych lub nieleczonych wcześniejszych dysfunkcji. Liczną grupę pacjentów z zaburzeniami układu ruchu stanowią dzieci i młodzież. Celem pracy była ocena wpływu nadmiernej masy ciała i ustawienia koślawego kolan na symetrię i zakres ruchu miednicy w chodzie u dzieci. Materiał i metody: W badaniu uczestniczyło 192 uczniów szkół podstawowych w wieku od 11 do 13 lat z okolic miasta Tarnowa. Oceniono ustawienie kończyn dolnych mierząc odstęp pomiędzy kostkami przyśrodkowymi w pozycji stojącej ze złączonymi kolanami. Symetrię ruchu miednicy w chodzie zbadano za pomocą urządzenia BTS G-Walk. Wyniki: Nadmierną masę ciała, podobnie jak koślawość kolan, częściej diagnozowano u chłopców. Zanotowano istotny związek pomiędzy nadwagą i otyłością a koślawością kolan. Stwierdzono również istotną różnicę w symetrii i zakresie ruchu miednicy w chodzie pomiędzy dziećmi z prawidłową i nadmierną masą ciała oraz pomiędzy dziećmi z prawidłowymi i koślawymi kolanami. Badanie współczynnika korelacji pokazało, że większy wpływ na ruch miednicy w chodzie ma BMI niż ustawienie kolan. Wnioski: Reedukacja chodu powinna być elementem kinezyterapii zarówno dzieci z koślawym ustawieniem kolan, jak i dzieci z nadmierną masą ciała.
EN
Introduction: Body posture, including the alignment of the knees, as well as being overweight or obese, has a measurable influence on the way one moves. Most of the somatic and motor dysfunctions, which are often a problem for adults, originated in their childhood. Ailments regarding motor functions among adults are often a consequence of a previously overlooked or untreated dysfunction. Children and teenagers are a large group of patients suffering from dysfunctions of such type. The goal of this research was to assess the degree of influence being overweight or obese and having valgus knees has over children’s pelvic movement symmetry during motion. Materials and methods: 192 primary school students, aged 11-13, from Tarnow and its surrounding areas took part in the study. The alignment of their lower limbs was realised through measuring the distances between their medial malleoli, while standing up, with legs joined at knees. The pelvic movement symmetry while walking was tested with the BTS G-Walk device. Results: Boys have been diagnosed with having excessive body weight and valgus knees alignment more often than girls. A crucial correlation between being overweight or obese and having valgus knees was noted. A notable difference in the pelvic movement symmetry during motion between overweight or obese children and those with correct body weight, as well as between children with valgus and correct knees alignment has been determined. Studying the correlation coefficient has shown that BMI is more relevant than knee alignment to the problem in question. Conclusion: Gait re-education should be a part of kinesitherapy both for the children with valgus knees and those with excessive body weight.
Przyjmuje się, że w przypadku chodu po schodach pomocne mogą być: laski, trójnogi, czwórnogi oraz kule. Bal-koniki, chodziki i podpórki zalicza się do sprzętu wykorzystywanego tylko w chodzie po plaskim podłożu. Celem pracy jest opisanie sposobu pokonania schodów przez pacjenta, niepotrafiącego poruszać się o kulach, za pomocą balkonika. Materiał i metody. W grupie badanych znalazło się 12 pacjentów po leczeniu operacyjnym z powodu złamania bliższej części kości udowej. Ze względu na ogólny stan zdrowia badanych nie rozpoczęto nauki chodzenia o kulach. W związku z miejscem zamieszania poszczególnych pacjentów (piętrowe domy jednorodzinne, piętrowe domy w zabudowie szeregowej) zaproponowano im i ich rodzinom naukę chodzenia z balkonikiem po schodach. Wnioski: 1) Wejście po schodach pacjenta niemogącego poruszać się o kulach proponowanym spo-sobem jest możliwe. W lokomocji tej niezbędna jest asekuracja drugiej osoby. 2) Zejście po schodach pacjenta niemogącego poruszać się o kulach proponowanym sposobem jest możliwe. W lokomocji tej również niezbędna jest asekuracja drugiej osoby.
EN
It is assumed that walking canes, tripods, quadrupeds and crutches can be helpful in the case of stair climbing. Walking frames and supporters are counted as equipment used only on flat ground. The aim of the research is to prove the possibility for a patient, who cannot walk on crutches, of climbing stairs with a support of a walking frame. Material and methods. In the research group there were 12 patients on post-operational treatment caused by trochanteric fractures. Because of the general state of the research patients' health, they didn't start learning using the crutches. On account of the type of accommodation the patients lived in (two-floor detached houses, terraced houses) they and their families were proposed learning to climb stairs with use of walking frame. Findings: 1) Ascending stairs by a patient who cannot walk on crutches is possible applying the proposed method. Assistance of another person is inevitable in this way of locomotion. 2) Descending stairs by a patient who cannot walk on crutches is possible using the proposed method. Assistance of another person is also inevitable in this way of locomotion.
Introduction. The involutive changes of humans’ gait are multifactoral and they have negative influence on its quality. Among other symptoms, decrease in muscle strength and range of motion are the most frequently mentioned. These factors have an impact on some spatiotemporal gait parameters, such as decrease in gait velocity and step length and increase in step width. Study Aim. The aim of the study was to assess the influence of two different forms of training on spatiotemporal parameters of elders’ gait. Material. Fifty-nine participants joined the project. Medical examination and stress test were conducted to exclude any health contraindications. Participants were divided into two groups: versatile training (TW), and training in low positions (TN). Fourteen participants in each group finished the research protocol. Method. FDM Zebris platform was used to register the spatiotemporal parameters of subjects’ gait. Their task was to walk through it with their natural velocity three times. The training protocol took 12 weeks, twice a week meetings lasting 45 minutes. The main difference between the training groups was that the exercises of locomotion and in high positions were excluded in the TN group. Statistical analysis was conducted with Statistica software. Results. As a result of TW group, six parameters changed statistically significantly. step length of the right lower extremity step length of the right lower extremity (as a % of leg lenght) and step time of the left and right lower extremity, stride time and cadence. The other parameters showed different tendencies, but their changes cannot be assigned to the training protocol. TN subjects did not show any significant changes in the parameters considered. Conclusions. Changes of gaits’ quality are multifactor therefore they require future investigation. They need to be identified in order to be modified in the course of training or therapy. The exercise selection should include structurally similar tasks to the ones’ they desire to develop.
Zaburzenia równowagi i chodu należą do najbardziej niepokojących objawów starzenia. Ich następstwem są upadki, które stanowią główną przyczynę złamań kośćca u starszych osób. Celem pracy była ocena stanu równowagi i zdolności lokomocyjnych starszych osób zamieszkujących w domu opieki społecznej. Badaniami objęto 58 osób (30 kobiet i 28 mężczyzn) w wieku od 65 do 93 lat (średnio 77,1 ± 7,7), zamieszkujących w Domu Pomocy Społecznej "Pogodna Jesień" w Cieplicach. Ocenę równowagi i chodu przeprowadzono za pomocą testu Tinetti, który pozwala oszacować zagrożenie upadkami. Uzyskane wyniki wskazują na znaczne deficyty w utrzymywaniu równowagi i chodzie badanych osób. Tylko u 13% uczestników wynik wskaźnika Tinetti wskazał na niewielkie ryzyko upadku. Umiarkowane zagrożenie upadkiem stwierdzono u 50% osób, a u 37% prawdopodobieństwo, że do upadku dojdzie, było pięciokrotnie większe niż u pozostałych. Wykazano istotny związek między wiekiem a stopniem zagrożenia upadkami. W badanej grupie deficyty w równowadze ciała i związane z tym podwyższone ryzyko upadków dotyczyły 87% starszych osób. W zapobieganiu upadkom szczególna rola przypada rehabilitacji ruchowej.
EN
Disorders of balance and gait are one of the most disturbing symptoms of ageing. They lead to repeated falls, that are the main reason for injuries in the elderly. They result in suffering, disability, loss of self-dependence and social isolation of the affected individuals. The aim of the study was to evaluate the balance and locomotor abilities in the elderly people living in a nursing home. The study was performed on 58 individuals (30 women and 28 men) aged 65-93 (mean age 77.1 ± 7.7) living in a nursing home in Jelenia Góra. Balance and gait were evaluated by means of the Tinetti test. The result of the test, called Tinetti mobility index, can help evaluate the risk of falls. The results suggest significant deficits in maintaining balance and quality of gait in the examined. The results in women were worse than in men, yet he differences were not statistically significant. Only in four people (13%) the Tinetti index showed the risk of falling. The risk of falling was observed in 15 patients (50%) and in eleven of them the probability of falls was 5 times higher than in the rest. Age significantly influenced body balance and the risk of falls. In the examined group the deficits of body balance and the increased risk of falling related to them were observed in 87% of the elderly. Physiotherapy plays an important role in prophylaxis of falls and it should be introduced in nursing homes for the elderly.
Mózgowe porażenie dziecięce (mpd) jest schorzeniem dotykającym około 50 tys. dzieci w Polsce. Najczęstszym przejawem mpd jest patologia chodu, która ma podłoże neurologiczne i rozwojowe. Badania biomechaniczne mają określić obiektywne parametry chodu u dzieci z mpd i ich zmiany w trakcie prowadzonej rehabilitacji. Analiza przedstawiona w niniejszej pracy jest trójwymiarową kinematyczną analizą ruchu, w której użyto kamer cyfrowych i systemu Simi Motion oraz kamer podczerwieni i systemu BTS Smart. W artykule przedstawiono wyniki badań trójki dzieci z mpd, chodzących samodzielnie, oraz dziecka sprawnie chodzącego. Do charakterystyki lokomocji dzieci wybrano przemieszczenia kątowe stawu kolanowego prawego i lewego współdziałającego z ruchem stopy prawej i lewej z podziałem na fazę wymachu i podporu. Na podstawie przeprowadzonych eksperymentów stwier-dzono u jednego dziecka znaczną poprawę chodu, u drugiego proces ten przebiegł wolniej i słabiej, a trzecie dziecko nie zmienilo poprawności chodu. Prowadzone badania mają znaczenie diagnostyczne. Kinematyczna analiza lokomocji dzieci pozwala rozpoznać poprawę lub pogorszenie chodu dzieci w procesie rehabilitacji.
EN
Cerebral palsy (CP) in children is a group of disorders, which afflicts many children; about 50 thousand of these children live in Poland. The most frequent CP symptom is gait pathology of neurological and developmental basis. Biomechanical tests shall determine the objective gait parameters in children with CP and their changes during the rehabilitation process. The analysis presented in this paper is a three-dimensional kinematic movement analysis, in which digital cameras and Simi Motion system, as well as infrared cameras and BTS Smart system were used. The article includes test results of three children with CP, walking independently and a properly walking child from the Rehabilitation and Neuropsychiatry Centre in Mikoszów. Standard rehabilitation was increased by exercises on mechanical horse, which supplement natural hippoterapy. Angular displacement of the right and left knee joint cooperating with the movement of right and left foot with the division into swing and support phase has been chosen for the characteristics of the children's locomotion. On the basis of performed experiments, a significant improvement in the gait of one child was stated, in case of the second child the process was much slower and weaker, and the third child did not change the gait correctness. The executed examination is of diagnostic meaning. Kinematic analysis of locomotion in children allows identifying the improvement or deterioration of gait in children in the process of rehabilitation, and it can advise the doctor and physiotherapist, what to focus on, in order to consciously improve and establish gait habits in children.
Wprowadzenie: Aktualnie prowadzone badania naukowe podkreślają znaczenie informacji sensorycznej dla kontroli ruchowej. Informacja multisensoryczna może być przetwarzana przez mózg nawet wtedy, gdy jego uszkodzenie obejmuje multimodalne obszary kory kojarzeniowej oraz specyficzne obszary kory czuciowej. Cel: Celem badania była ocena wpływu stymulacji czuciowej stopy na równowagę i funkcję chodu osób z niedowładem połowiczym z uwzględnieniem wieku badanych, okresu, który upłynął od udaru oraz jego lokalizacji. Materiał i metody: Badaniami prowadzonymi od marca do lipca 2016 roku objęto grupę czterdzie-stu kolejnych chorych (wiek 39-86 lat; średnia=68,3; SD= 10,2) leczonych w ośrodku rehabilitacyjnym NZOZ Pasternik w Modlniczce, przebywających na 6 tygodniowym turnusie rehabilitacyjnym. W dniu konsultacji lekarskiej przeprowadzono wywiad i ankietę na temat stanu zdrowia, a następnie przeprowadzono badanie przedmiotowe złożone z 3 testów funkcjonalnych: testu dwóch wag, testu Tinetti, oraz testu „Wstań i idź”. Pomiary wykonano czterokrotnie: przed rozpoczęciem usprawniania, pierwszego dnia po fizjoterapii, po 4 tygodniowym okresie usprawniania oraz po 2 tygodniowej przerwie. Codzienna rehabilitacja obejmowała indywidualną stymulację sensoryczną stopy wykonaną przez fizjoterapeutę zgodnie z założeniami koncepcji Bobath. Dodatkowo pacjenci mieli dostęp do sali gimnastycznej, gdzie wykonywali samodzielnie zadane ćwiczenia ukierunkowane na sensorykę stopy przy wykorzystaniu odpowiednich przyrządów terapeutycznych. Wyniki: Czterotygodniowa fizjoterapia dedykowana stymulacji sensorycznej niedowładnej stopy wpłynęła na poprawę równowagi i funkcji chodu u chorych z niedowładem połowiczym. Znamienną poprawę w symetrii rozkładu ciężaru ciała na dwóch wagach zanotowano już po pierwszej stymulacji. Wyniki obu testów chodu po zakończeniu fizjoterapii pozwoliły na zakwalifikowanie chorych do grupy osób o średnim ryzyku upadku z wyjściowo wysokiego ryzyka. Badanie wykazało również korzystniejszy wpływ terapii na usprawnienie osób młodszych, z porażeniem lewostronnym oraz krótszym okresem od incydentu udarowego. Wnioski: Stymulacja sensoryczna stopy jest nieinwazyjnym i skutecznym narzędziem terapeutycznym w przywracaniu równowagi i poprawie chodu u osób z niedowładem połowiczym po przebytym udarze mózgu.
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Background: Current research emphasizes the importance of sensory afference for movement control. Multisensory information may be processed in the brain even when its damage is located in multimodal association areas and specific sensory cortex. Aim: The aim of the study was to assess the influence of sensory stimulation of the hemiparetic foot on balance and gait improvement in stroke patients with respect to the their age, time from onset and location of stroke. Material and methods: The study was carried out from March to July 2016 and involved 40 consecutive inpatients (age 39-86 years; mean=68,3; SD=10.2) staying at the “Pasternik” rehabilitation centre in Modlniczka for 6 weeks. On the day of the physician’s examination, medical history was recorded and patients were interviewed about their health condition. After that, three functional tests were carried out: the Two-scale test, the Tinetti test and the Timed Up and Go test (TUG). The measurements were taken: before sensory stimulation, after the first treatment, after 4 weeks of treatment and at 2 weeks of follow- up. Every day, treatment consisted of individual sensory stimulation of the hemiparetic foot performed by a physiotherapist according to the specific principles of the Bobath concept. Additionally, aimed at foot sensory stimulation, patients performed their own supervised exercises using designated equipment at a gym. Results: 4 weeks of treatment aimed at the sensory stimulation of the hemiparetic foot influenced balance and gait improvement in stroke survivors. Significant improvement in weight distribution on the Two-scale test was detected immediately after the first stimulation. The results of both gait tests measured after 4 weeks of physiotherapy allowed to classify subjects into the group of average fall risks in comparison to the initial high-risk group. The study indicated more efficacy of sensory stimulation in younger patients with left side paresis and a shorter period after stroke onset. Conclusion: Foot sensory stimulation is a non-invasive, efficient therapeutic tool for regaining balance and gait improvement in hemiparetic subjects after stroke.
Nowadays, more and more scientific reports highlight the importance of cognitive skills in motor control. It is believed that movement also engages higher mental processes such as executive functions, attention and working memory. Executive functions include cognitive processes, such as the ability to initiate, plan, modify and control behaviour. They play an integrative role in the processing of information, including both cognitive and behavioural elements, necessary for goal-directed and effective action. Executive functions play a key role in the regulation of gait in the case of taking new steps or modifying previously learned motor programmes. Neuroimaging studies show that there is a common pattern of neural activity for walking, executive functions and attention, involving the frontal cortex and cortico-subcortical neuronal network. Many studies have shown that the impairment of executive functions may contribute to gait disturbances and increased risk of falls. Executive functions allow movement patterns to be modified, and enable the introduction of adaptive compensatory strategies in response to changing internal and external environmental stimuli. Studies with dual-task paradigm also stress the importance of attention in maintaining the control over gait. The addition of a cognitive task slows gait in the elderly. The incidence of falls is higher in subjects with dementia. The identification of cognitive risk factors of falls may allow more effective diagnostic and therapeutic methods to be developed. The aim of this study was to elucidate the relationship between cognitive function, i.e. executive functions and attention, and the risk of falls.
PL
Współcześnie powstaje coraz więcej doniesień naukowych podkreślających znaczenie sprawności funkcji poznawczych w kontroli motorycznej. Uważa się, że chód angażuje także wyższe procesy psychiczne: funkcje wykonawcze, uwagę i pamięć operacyjną. Funkcje wykonawcze obejmują takie procesy poznawcze, jak zdolność do inicjowania, planowania, modyfikowania i kontroli zachowania. Pełnią integracyjną funkcję w przetwarzaniu informacji – obejmują elementy poznawcze i behawioralne niezbędne do skutecznego działania, zorientowanego na cel. Funkcje wykonawcze odgrywają kluczową rolę w regulacji chodu w przypadku podejmowania nowych czynności bądź modyfikowania uprzednio wyuczonych programów ruchowych. Jak dowodzą badania neuroobrazowe, dla chodu, funkcji wykonawczych i uwagi istnieje wspólny wzorzec aktywności neuronalnej, obejmujący korę czołową i jej korowo-podkorową sieć neuronalną. W wielu badaniach wykazano, że osłabienie funkcji wykonawczych może przyczyniać się do powstawania zaburzeń chodu i zwiększać ryzyko upadków. Funkcje wykonawcze umożliwiają modyfikowanie wzorców ruchowych, jak również wprowadzanie adaptacyjnych strategii kompensacyjnych w odpowiedzi na zmieniające się bodźce – pochodzące ze środowiska zarówno wewnętrznego, jak i zewnętrznego. Badania w paradygmacie podwójnego zadania podkreślają też znaczenie uwagi w utrzymaniu kontroli chodu. Dodanie zadania angażującego funkcje poznawcze przekłada się w grupie ludzi starszych na spowolnienie chodu. Częstość upadków jest wyższa u osób z otępieniem. Identyfikacja poznawczych czynników ryzyka upadków może pozwolić na opracowanie skuteczniejszych metod diagnostycznych i terapeutycznych. Celem niniejszej pracy jest próba wyjaśnienia mechanizmów relacji między funkcjami poznawczymi – funkcjami wykonawczymi i uwagą – a ryzykiem upadków.
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