The effects of different frequencies of rhythmic acoustic stimulation on gait stability in healthy elderly individuals: a pilot study

The efficacy of rhythmic acoustic stimulation (RAS) to improve gait and balance in healthy elderly individuals is controversial. Our aim was to investigate, through 3D gait analysis, the effect of different types of RAS (fixed frequency and based on subject-specific cadence), using conventional gait parameters and the trunk displacement as readouts. Walking at a fixed frequency of 80 bpm, the subjects showed extended duration of gait cycle and increased gait variability while the same individuals, walking at a fixed frequency of 120 bpm, showed reduced trunk sway and gait cycle duration. With regard to the RAS at subject-specific frequencies, walking at 90% of the subject-specific average cadence did not significantly modify the gait parameters, except for the speed, which was reduced. In contrast, walking at 100% and 110% of the mean cadence caused increased stride length and a slight reduction of temporal parameters and trunk sway. In conclusion, this pilot study shows that using RAS at fixed frequencies might be an inappropriate strategy, as it is not adjusted to individual gait characteristics. On the other hand, RAS frequencies equal to or slightly higher than each subject's natural cadence seem to be beneficial for gait and stability.

Effects of lower trunk movement in flat-back syndrome during stair climbing: A technical note

OBJECTIVE: This study investigated the differences in trunk sway during stair climbing between people with normal spinal alignment and people with flat-back syndrome. METHODS: Twelve male volunteers with flat-back syndrome (global angle < 20 degrees) and 12 male volunteers with normal spinal alignment (global angle between 20 degrees and 30 degrees) were enrolled. An accelerator was attached to the third lumbar spine and the sway of each participant’s trunk was measured during stair climbing. RESULT: Participants with flat-back syndrome showed significant differences in vector, anteroposterior sway, and vertical sway of the trunk during stair climbing (p< 0.05). However, mediolateral sway of the trunk and gait time did not significantly differ between groups (p> 0.05). CONCLUSION: Our findings can be used as baseline data for prevention of back pain. Furthermore, increased trunk sway can cause increased energy usage, leading to inefficient gait. Further research is needed to prevent this problem.

Case of cerebellar ataxia successfully treated by virtual reality-guided rehabilitation

A male patient in his 40s was transferred to our hospital for rehabilitation of ataxia after right cerebellar and brainstem infarction. After 3 weeks of conventional physical therapy, his activities of daily life successfully improved with an increase in the functional impedance measure from 101 to 124. However, he still fell short of gaining a higher level of balance function, which was necessary for his job as a standup forklift driver. We introduced virtual reality-guided balance training. The training was performed for approximately 40 min on weekdays for 2 weeks. As a result, the Scale for the Assessment and Rating of Ataxia score decreased from 5 to 1, Functional Balance Scale score improved from 48 to 56, and Mini-Balance Evaluation Systems Test score increased from 20 to 28. The trunk sway disappeared clinically. He regained confidence and returned to work after an additional 2 weeks of physical therapy.

Creation of an Evidence-Based Physical Therapy Program for Adults with XLH: Translational Application of an Interprofessional Clinical Study

X-linked hypophosphatemia (XLH) arises due to inactivating mutations of the PHEX gene resulting in elevated circulating levels of the hormone FGF23, producing phosphaturia and impaired intestinal phosphate absorption. XLH is a lifelong metabolic disease with musculoskeletal comorbidities that dominate the adult clinical picture, and are resistant to standard therapies. We have previously reported the physical and functional impact of the adult disorder (J Clin Endocrinol Metab. 2020 Apr 1;105(4)). Bilateral and diffuse enthesophytes, degenerative arthritis and osteophytes were reported at the spine and synovial joints across subjects. Passive range of motion (ROM) was decreased at the spine, hips, knees, and ankles compared to controls. Gait analysis, relative to controls, revealed increased step width, markedly increased lateral trunk sway, and physical restriction at the hip, knees and ankle joints that translated into limitations through the gait cycle. These studies have been translated into an evidence-based physical therapy (PT) intervention study to address these major physical and functional comorbidities. Participants were enrolled in a remote 12-week PT program consisting of balance exercises and basic stretches with/without resistance. Subjects were evaluated at baseline and at every 4-weeks to assess ROM, gait, and functional ability. Several validated tools were employed to assess overall function: Berg Balance Scale, the Timed Up and Go (TUG) Test, and the Five Times Sit to Stand Test (5XSST). Subjective questionnaires, including the Lower Extremity Functional Scale (LEFS) and Activities-Specific Balance Confidence (ABC) Scale, were administered along with a weekly survey. At the conclusion of the study, minimal to modest improvements were seen in active ROM for the upper and lower extremity which reflect the significant bony restriction caused by XLH. However, improvements were seen in functional measures including the Berg Balance Scale, TUG, 5XSST, LEFS, and ABC. Weekly surveys indicated that participants improved their ability to balance, perform activities of daily living (ADLs), walk, and bend down to reach the ground. Results from this study will be applied to the creation of an evidence-based PT program to maintain functional capacity and improved ability to perform ADLs across the lifespan.

The effects of different frequencies of rhythmic acoustic stimulation on gait kinematics and trunk sway in healthy elderly population

ABSTRACTThe use of rhythmic acoustic stimulation (RAS) in improving gait and balance in healthy elderly subjects has been widely investigated. However, methodologies and results are often controversial. In this study, we hypothesize that both the kinematic features of gait and stability, depend on the frequency at which RAS is administered. Our aim was to observe, through 3D Gait Analysis, the effect of different types of RAS (at a fixed frequency or based on the average cadence of each subject) on both gait spatio-temporal parameters and stability. The latter was estimated through an innovative measure, the trunk displacement index (TDI) that we have recently implemented. We observed that the low frequencies RAS led to a general slowdown of gait, which did not provide any clear benefit and produced harmful effects on stability when the frequency became too low compared to the individual natural frequency. On the contrary, the high frequencies of RAS showed a slight acceleration of gait, accompanied by better stability (as documented by a lower TDI value), regardless of the type of RAS. Finally, the RAS equal to the individual natural cadence also produced an increase in stability.