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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 -
Journal of Physiological Anthropology Oct 2016This study aimed to examine the association of walking difficulty with bone mass or bone turnover among community-dwelling Japanese people aged 40 years and older.
BACKGROUND
This study aimed to examine the association of walking difficulty with bone mass or bone turnover among community-dwelling Japanese people aged 40 years and older.
METHODS
We studied 1097 community-dwelling Japanese people aged 40 years and older (379 men and 718 women) who were invited to participate in periodic health examinations in 2006-2009. Walking difficulty was defined as having difficulty walking 100 m on a level surface (self-administered questionnaire). Calcaneal stiffness index (bone mass) was measured by quantitative ultrasound. Spot urine samples were collected, and urinary N-terminal cross-linking telopeptide of type I collagen (NTx) was measured. Values were corrected for creatinine (Cre) concentration.
RESULTS
The prevalence of walking difficulty was significantly higher in women than in men (7.4 vs. 3.4 %, p = 0.011) and significantly increased with age in men (p for trend = 0.02) and women (p for trend <0.001). In univariate analysis, men and women with walking difficulty were older (p < 0.001) and had a lower stiffness index (p < 0.001), compared with those without walking difficulty. Among women, individuals with walking difficulty had significantly higher urinary NTx/Cre than those without walking difficulty (p < 0.001); however, this was not so among men (p = 0.39). Multiple regression analysis adjusted for age, weight, and menopausal status showed a significant association between walking difficulty and lower stiffness index in men (p = 0.004) and women (p = 0.005). In women, walking difficulty was significantly associated with higher NTx/Cre (p = 0.001), but not in men (p = 0.35).
CONCLUSIONS
Walking difficulty may contribute to low bone mass in both sexes but might cause high bone turnover in women only.
Topics: Adult; Aged; Aged, 80 and over; Aging; Biomarkers; Bone Density; Bone Resorption; Female; Humans; Male; Middle Aged; Mobility Limitation; Walking
PubMed: 27729080
DOI: 10.1186/s40101-016-0114-6 -
Pediatric Physical Therapy : the... 2012
Topics: Child; Delaware; Humans; Infant; Mobility Limitation; Motor Vehicles; Physical Therapy Modalities; Self-Help Devices; Wheelchairs
PubMed: 22466377
DOI: 10.1097/PEP.0b013e31824e9045 -
Lancet (London, England) Oct 2022
Topics: Ataxia; Erectile Dysfunction; Fragile X Syndrome; Humans; Male; Mobility Limitation; Syndrome; Tremor
PubMed: 36183730
DOI: 10.1016/S0140-6736(22)01587-2 -
Clinical Nursing Research Mar 2020
Topics: Aging; Cognition; Delivery of Health Care; Humans; Medication Adherence; Mobility Limitation; Patient-Centered Care
PubMed: 32036695
DOI: 10.1177/1054773820906667 -
Orthopedic Nursing 2018
Topics: Canes; Humans; Mobility Limitation; Orthopedic Nursing; Orthopedics
PubMed: 29782459
DOI: 10.1097/NOR.0000000000000453 -
BMJ (Clinical Research Ed.) May 2022
Topics: Aged; Aging; Humans; Independent Living; Mobility Limitation
PubMed: 35545267
DOI: 10.1136/bmj.o1084 -
The Journals of Gerontology. Series A,... Sep 2017Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be...
BACKGROUND
Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty.
METHODS
Community-dwelling people aged 75-90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761) years later. Life-space mobility was assessed annually with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Self-reported ability to walk 2 km was assessed at baseline and categorized into "no difficulty," "no difficulty but task modifications" (reduced frequency, given up walking, walking slower or resting during walking) and "difficulty." The analyses were adjusted for age, gender, number of chronic conditions, cognitive impairment, lower extremity performance and education.
RESULTS
The life-space mobility score was highest and remained stable over 2-years among those with no walking difficulties at baseline and lowest and showing a steady decline among those with walking difficulties. Those with task modifications formed the middle group. They showed no marked changes in life-space mobility during the first year, but significant decline during the second year.
CONCLUSION
Task modifications in walking may help community-dwelling older people to postpone life-space mobility decline.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Disability Evaluation; Female; Finland; Geriatric Assessment; Humans; Independent Living; Male; Mobility Limitation; Quality of Life; Surveys and Questionnaires; Task Performance and Analysis; Walking
PubMed: 28329074
DOI: 10.1093/gerona/glw348 -
Disability and Rehabilitation Jan 2022Understanding personal experiences of real-world walking for stroke survivors could assist clinicians to tailor interventions to their clients' specific needs. We...
PURPOSE
Understanding personal experiences of real-world walking for stroke survivors could assist clinicians to tailor interventions to their clients' specific needs. We explored the research questions: "What does real-world walking mean to people after stroke and how do they think it can be better?"
METHOD
Using an Interpretive Descriptive methodology, we purposively sampled eight stroke survivors who reported difficulty walking in the real-world. We sought diversity on key participant characteristics. Participants were interviewed using a semi-structured guide. Data were analysed with thematic analysis.
RESULTS
Many found real-world walking, particularly in the outdoors, created opportunities for freedom from dependence and a visible step by step progress, which generated hope for future recovery. Conversely, when participants did not experience sufficient progress, they expressed negative emotions. Participants strove to overcome challenges to their walking goals using everyday routines, planning skills, and confidence building experiences to motivate themselves. They also drew on, and extended, social resources highlighting the relational aspects of real-world walking.
CONCLUSIONS
Walking in their real-world provided a meaningful, desirable, but challenging goal for participants that required significant emotional effort. Successful progress in real-world walking builds confidence and hope and can contribute to psychological wellbeing by providing opportunities for successful mastery and social connectedness.IMPLICATIONS FOR REHABILITATIONReal-world settings can be unpredictable which makes walking in the real-world after stroke demanding.Positive experiences of walking in the real-world can provide significant psychological benefits to stroke survivors.Many survivors need to carefully concentrate on the act of walking in outdoor settings.Pre-planning routes, confidence-building experiences and developing daily routines may help patients overcome these challenges.
Topics: Adaptation, Psychological; Attitude to Health; Humans; Mobility Limitation; Qualitative Research; Stress, Psychological; Stroke; Stroke Rehabilitation; Survivors; Walking
PubMed: 32466665
DOI: 10.1080/09638288.2020.1767704 -
BMC Geriatrics Dec 2023Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of... (Randomized Controlled Trial)
Randomized Controlled Trial
A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial.
BACKGROUND
Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.
METHODS
GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2 continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.
RESULTS
All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.
CONCLUSIONS
This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.
Topics: Aged; Humans; Exercise; Exercise Therapy; Mobility Limitation; Walking
PubMed: 38082248
DOI: 10.1186/s12877-023-04524-7