The aim of this study was to test the inter- and intraobserver reliability of the Physician Rating Scale (PRS) and the Edinburgh Visual Gait Analysis Interval Testing (GAIT) scale for use in children with cerebral palsy (CP). Both assessment scales are quantitative observational scales, evaluating gait. The study involved 24 patients ages 3 to 10 years (mean age 6.7 years) with an abnormal gait caused by CP. They were all able to walk independently with or without walking aids. Of the children 15 had spastic diplegia and 9 had spastic hemiplegia. With a minimum time interval of 6 weeks, video recordings of the gait of these 24 patients were scored twice by three independent observers using the PRS and the GAIT scale. The study showed that both the GAIT scale and the PRS had excellent intraobserver reliability but poor interobserver reliability for children with CP. In the total scores of the GAIT scale and the PRS, the three observers showed systematic differences. Consequently, the authors recommend that longitudinal assessments of a patient should be done by one observer only.
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In order to achieve a level of community involvement and physical independence, being able to walk is the primary aim of many stroke survivors. It is therefore one of the most important goals during rehabilitation. Falls are common in all stages after stroke. Reported fall rates in the chronic stage after stroke range from 43 to 70% during one year follow up. Moreover, stroke survivors are more likely to become repeated fallers as compared to healthy older adults. Considering the devastating effects of falls in stroke survivors, adequate fall risk assessment is of paramount importance, as it is a first step in targeted fall prevention. As the majority of all falls occur during dynamic activities such as walking, fall risk could be assessed using gait analysis. It is only recent that technology enables us to monitor gait over several consecutive days, thereby allowing us to assess quality of gait in daily life. This thesis studies a variety of gait assessments with respect to their ability to assess fall risk in ambulatory chronic stroke survivors, and explores whether stroke survivors can improve their gait stability through PBT.
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BackgroundExercise-induced fatigue is a common consequence of physical activities. Particularly in older adults, it can affect gait performance. Due to a wide variety in fatiguing protocols and gait parameters used in experimental settings, pooled effects are not yet clear. Furthermore, specific elements of fatiguing protocols (i.e., intensity, duration, and type of activity) might lead to different changes in gait parameters. We aimed to systematically quantify to what extent exercise-induced fatigue alters gait in community-dwelling older adults, and whether specific elements of fatiguing protocols could be identified.MethodsThis systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. In April 2023, PubMed, Web of Science, Scopus, Cochrane and CINAHL databases were searched. Two independent researchers screened and assessed articles using ASReview, Rayyan, and ROBINS-I. The extracted data related to spatio-temporal, stability, and variability gait parameters of healthy older adults (55 +) before and after a fatiguing protocol or prolonged physical exercise. Random-effects meta-analyses were performed on both absolute and non-absolute effect sizes in RStudio. Moderator analyses were performed on six clusters of gait parameters (Dynamic Balance, Lower Limb Kinematics, Regularity, Spatio-temporal Parameters, Symmetry, Velocity).ResultsWe included 573 effect sizes on gait parameters from 31 studies. The included studies reflected a total population of 761 older adults (57% female), with a mean age of 71 (SD 3) years. Meta-analysis indicated that exercise-induced fatigue affected gait with a standardized mean change of 0.31 (p < .001). Further analyses showed no statistical differences between the different clusters, and within clusters, the effects were non-uniform, resulting in an (indistinguishable from) zero overall effect within all clusters. Elements of fatiguing protocols like duration, (perceived) intensity, or type of activity did not moderate effects.DiscussionDue to the (mainly) low GRADE certainty ratings as a result of the heterogeneity between studies, and possible different strategies to cope with fatigue between participants, the only conclusion that can be drawn is that older adults, therapist, and researchers should be aware of the small to moderate changes in gait parameters as a result of exercise-induced fatigue.
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