-
NeuroRehabilitation 2017One third of individuals after stroke report an inability to walk in the community. Community mobility requires walking adaptability - the ability to adjust one's... (Review)
Review
BACKGROUND
One third of individuals after stroke report an inability to walk in the community. Community mobility requires walking adaptability - the ability to adjust one's stepping pattern to meet environmental demands and task goals. Walking on uneven terrain (e.g. grass, gravel) has unique requirements and is a critical component of walking adaptability that has not been investigated in the post-stroke population.
OBJECTIVE
To summarize current knowledge of biomechanical and neuromuscular modifications during uneven terrain negotiation in healthy individuals and discuss implications of post-stroke impairments.
METHODS
Review of eleven studies, identified through a search of relevant literature on PubMed and CINAHL.
RESULTS
On uneven terrain, healthy adults demonstrate numerous gait modifications including a lowered center of mass, increased muscle co-contraction during stance and exaggerated or increased toe clearance during swing. After stroke, changes in muscle activity and limb coordination will likely result in difficulty or inability performing these modifications that healthy adults use to maintain stability and safety when walking on uneven terrain.
CONCLUSIONS
Studies of biomechanical and neuromuscular control of walking on uneven terrain are needed to quantify mobility limitations in adults post-stroke. Such investigations will contribute to the understanding of mobility impairments after stroke and the design of critically important intervention strategies.
Topics: Adult; Biomechanical Phenomena; Disability Evaluation; Humans; Mobility Limitation; Stroke; Walking
PubMed: 28946584
DOI: 10.3233/NRE-172154 -
The Lancet. Neurology Dec 2023
Topics: Humans; Parkinson Disease; Mobility Limitation; Quality of Life
PubMed: 37865117
DOI: 10.1016/S1474-4422(23)00376-9 -
Journal of Rehabilitation Research and... 2016Mobility scooters are three- or four-wheeled power mobility devices regularly used by people who have difficulty ambulating. They also differ from power wheelchairs in... (Review)
Review
Mobility scooters are three- or four-wheeled power mobility devices regularly used by people who have difficulty ambulating. They also differ from power wheelchairs in terms of their driving controls, programmability, seating, and mounting method. Given their growing popularity and anecdotal concerns around their use, a scoping review was undertaken to identify empirical research about mobility scooters and to analyze their study design and purpose. Data sources included MedLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsychINFO. Thirty-two studies met the inclusion criteria. Most studies were descriptive in nature and reported information about scooter users' demographics, scooter-related activities, and accidents. The most common study design was a pre- and postintervention followed by a cross-sectional survey and retrospective review. Despite the increasing use of mobility scooters, surprisingly little scooter-related research has been conducted. Given the nature of most of the research in this area, further empirical evidence is needed to develop a better understanding about the frequency and causes of scooter accidents and the efficacy of interventions to improve users' skills, mobility, and safety.
Topics: Accident Prevention; Biomedical Research; Consumer Product Safety; Education, Nonprofessional; Equipment Safety; Humans; Mobility Limitation; Self-Help Devices
PubMed: 27898156
DOI: 10.1682/JRRD.2015.05.0084 -
The Journals of Gerontology. Series A,... May 2019
Topics: Accidental Falls; Aged; Creatine; Humans; Incidence; Male; Mobility Limitation; Physical Functional Performance; Prospective Studies
PubMed: 30215688
DOI: 10.1093/gerona/gly180 -
Aging Clinical and Experimental Research Oct 2021Outdoor mobility enables participation in essential out-of-home activities in old age.
BACKGROUND
Outdoor mobility enables participation in essential out-of-home activities in old age.
AIM
To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking.
METHODS
Community-dwelling participants of AGNES study (2017-2018, initial age 75-85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed.
RESULTS
Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p < 0.001), and a smaller decline in autonomy in participation outdoors (p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p < 0.001 for both).
DISCUSSION
Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline.
CONCLUSION
Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.
Topics: Aged; Aged, 80 and over; COVID-19; Humans; Independent Living; Mobility Limitation; SARS-CoV-2; Walking
PubMed: 34417731
DOI: 10.1007/s40520-021-01956-2 -
Journal of Aging and Physical Activity Mar 2021The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those...
The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those with no difficulty. Community-dwelling 75-, 80-, or 85-year-old people (N = 479) wore accelerometers continuously for 3-7 days, and reported whether they perceived no difficulties, used walking modifications, or perceived difficulties walking 2 km. Daily walking minutes, walking bouts, walking bout intensity and duration, and activity fragmentation were calculated from accelerometer recordings, and cut points for increased risk for perceiving walking difficulties were calculated using receiver operating characteristic analysis. The authors' analyses showed that accumulating ≤83.1 daily walking minutes and walking bouts duration ≤47.8 s increased the likelihood of reporting walking modifications and difficulties. Accumulating walking bouts ≤99.4 per day, having walking bouts ≤0.119 g intensity, and ≥0.257 active to sedentary transition probability fragmented activity pattern were associated only with perceiving walking difficulties. The findings suggest that older people's accelerometer-based free-living walking reflects their self-reported walking capability.
Topics: Accelerometry; Aged; Aged, 80 and over; Humans; Independent Living; Mobility Limitation; Self Report; Walking
PubMed: 33780907
DOI: 10.1123/japa.2020-0389 -
Topics in Stroke Rehabilitation Apr 2018Background Stroke is the leading cause of severe disability and many survivors report long-term physical or cognitive impairments that may impact their ability to... (Review)
Review
UNLABELLED
Background Stroke is the leading cause of severe disability and many survivors report long-term physical or cognitive impairments that may impact their ability to achieve community mobility (CM).
PURPOSE
To determine the extent to which people with chronic stroke achieve CM compared to age-matched norms or non-neurologically impaired controls. Methods The StrokEDGE outcome measures were searched to identify validated tools that included >25% of items addressing CM. MEDLINE, CINAHL, Google Scholar, PubMed, PEDro and the Cochrane databases were searched from 2001 to 2015 with the identified outcome measures cross-referenced against search terms related to stroke and CM.
INCLUSION CRITERIA
utilized a validated CM outcome measure, chronic (>3 months post) stroke survivors, and randomized controlled trial, observational or cohort study design. One reviewer screened the studies and performed data extraction and three performed quality appraisal. Fourteen studies met all inclusion criteria. Results Stroke survivors have impaired CM as demonstrated by 30-83% of normative or non-stroke subject CM scores. As time post-stroke increased, CM improved only slightly. Factors found to correlate with the CM were age, education, general well-being, emotional state, motor function and coordination, independence in activities of daily living, balance, endurance and driving status. Limitations of this review include a relatively high functioning cohort, no meta-analysis and reliance on outcome measures not specifically designed to measure CM. Conclusion Survivors of stroke may experience a significant decrease in CM compared to people without neurological injury. Rehabilitation addressing motor function, coordination, independence in activities of daily living, balance and endurance may be important for achieving higher levels of CM. Outcome measures directly addressing CM are needed.
Topics: Community Participation; Humans; Mobility Limitation; Stroke Rehabilitation
PubMed: 29322861
DOI: 10.1080/10749357.2017.1419617 -
Journal of Pediatric Orthopedics Apr 2021Raphael, in his painting "Healing of the Lame Man" shows one lame man encountering St. Peter and St. John while another lame man waits his turn. Children with unusually...
Raphael, in his painting "Healing of the Lame Man" shows one lame man encountering St. Peter and St. John while another lame man waits his turn. Children with unusually muscular bodies are also depicted in the painting. The possible causes of lameness in the men and muscle hypertrophy in the children are discussed.
Topics: Gait; History, 16th Century; Humans; Hypertrophy; Italy; Mobility Limitation; Muscle, Skeletal; Paintings; Spiritual Therapies
PubMed: 33481477
DOI: 10.1097/BPO.0000000000001758 -
Physical Therapy Jan 2022The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and... (Observational Study)
Observational Study
OBJECTIVE
The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization.
METHODS
In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization.
RESULTS
For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11-14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82-2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission.
CONCLUSION
Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability.
IMPACT
An early assessment of walking function within days of stroke admission can help to streamline discharge planning.
LAY SUMMARY
Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.
Topics: Aged; Aged, 80 and over; Cohort Studies; Female; Gait Disorders, Neurologic; Hospitalization; Humans; Male; Middle Aged; Mobility Limitation; Patient Discharge; Predictive Value of Tests; Prevalence; Stroke Rehabilitation; Walking
PubMed: 34718796
DOI: 10.1093/ptj/pzab246 -
The Journals of Gerontology. Series A,... Mar 2019Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of... (Review)
Review
Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of physiologic systems. Measures of physical, cognitive and sensory, and psychosocial or emotional function predict important health outcomes like death and disability independently from the severity of a specific disease, cumulative co-morbidity, or disease severity measures. A growing number of clinical scientists in several subspecialties are exploring the utility of functional assessment to predict complication risk, indicate stress resistance, inform disease screening approaches and risk factor interpretation, and evaluate care. Because a substantial number of older adults in the community have some form of functional limitation, integrating functional assessment into clinical medicine could have a large impact. Although interest in functional implications for health and disease management is growing, the science underlying functional capacity, functional limitation, physical frailty, and functional metrics is often siloed among different clinicians and researchers, with fragmented concepts and methods. On August 25-26, 2016, participants at a trans-disciplinary workshop, supported by the National Institute on Aging and the John A. Hartford Foundation, explored what is known about the pathways, contributors, and correlates of physical, cognitive, and sensory functional measures across conditions and disease states; considered social determinants and health disparities; identified knowledge gaps, and suggested priorities for future research. This article summarizes those discussions.
Topics: Aging; Frailty; Humans; Mobility Limitation
PubMed: 29697758
DOI: 10.1093/gerona/gly093