Hong Kong Physiotherapy Journal

Instrumented gait analysis allows for the identification of walking parameters to predict cognitive decline and the worsening of dementia. The aim of this study was to perform a meta-analysis to better clarify which gait parameters are affected or modified with the progression of the dementia in a larger sample, as well as which gait assessment conditions (single-task or dual-task conditions) would be more sensitive to reflect the influence of dementia. Literature searches were conducted with the keywords “quantitative gait” OR “gait analysis” AND “dementia” AND “single-task” AND “dual-task,” and for “quantitative gait” OR “gait analysis” AND “dementia” AND “fall risk” on PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science. The results were used to perform a systematic review focussing on instrumental quantitative assessment of the walking of patients with dementia, during both single and dual tasks. The search was performed independently by two authors (C. R. and C. M.) from January 2018 to April 2020 using the PICOS criteria. Nine publications met the inclusion criteria and were included in the systematic review. Our meta-analysis showed that during a single task, most of the spatiotemporal parameters of gait discriminated best between patients with dementia and healthy controls, including speed, cadence, stride length, stride time, stride time variability, and stance time. In dual tasks, only speed, stride length, and stride time variability discriminated between the two groups. In addition, compared with spatial parameters (e.g. stride length), some temporal gait parameters were more correlated to the risk of falls during the comfortable walking in a single task, such as cadence, stride time, stride time variability, and stance time. During a dual task, only the variability of stride time was associated with the risk of falls.

Background: Low-intensity resistance training (RT) combined with neuromuscular electrical stimulation (NMES) is one method of exercise to improve the deterioration of physical function. However, it is unclear whether low-intensity RT combined with NMES (RT + NMES) can be safely implemented.

Objective: This study aimed to examine the influence of low-intensity RT + NMES on autonomic activity and cardiovascular responses in healthy adults.

Methods: This study was an open-label, randomized controlled cross-over trial. The exercise intensity of isometric knee extension RT was set to 40% of the maximum voluntary contraction (peak torque). NMES was adjusted to a biphasic asymmetrical waveform with the frequency maintained at 50 Hz and a phase duration of 300 $\mu$s. The difference in the change in autonomic activity and cardiovascular responses was compared by assessing heart rate variability, blood pressure, and heart rate during RT and $\mathrm{\text{RT}}+\mathrm{\text{NMES}}$.

Results: Twenty healthy male college students (mean age $21.0\pm 0.6$ years) participated in this study. The ratio of low- and high-frequency components of heart rate variability, systolic blood pressure, and heart rate increased during exercise in the RT and $\mathrm{\text{RT}}+\mathrm{\text{NMES}}$ sessions ($P<0.05$). There were no significant differences in autonomic activity and cardiovascular responses throughout the sessions during RT and $\mathrm{\text{RT}}+\mathrm{\text{NMES}}$.

Conclusion: In conclusion, our results demonstrated that low-intensity $\mathrm{\text{RT}}+\mathrm{\text{NMES}}$ was safe and did not induce excessive autonomic and cardiovascular responses in healthy adults.

Background: Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis.

Objective: The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis.

Methods: A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment.

Results: Within-group analysis has shown there is a statistically significant difference ($p<0.001$) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with $p$-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT ($p=0.029$) and soleus PPT ($p=0.013$).

Conclusion: It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus.

Clinical Trial Registration No: CTRI/2018/01/011398.

Name of registry: The Clinical Trials Registry — India (CTRI); https://ctri.nic.in.

Background: Musculoskeletal pain (MSP) conditions are common in the educational leaning environment and are often associated with poor ergonomic conditions.

Objective: This study investigated the prevalence, pattern and possible risk factors of MSP among undergraduate students of occupational therapy and physiotherapy in a South African university.

Methods: A cross-sectional survey using an internet-based self-designed electronic questionnaire was used to obtain information about participants’ socio-demography, ergonomic hazards, MSP, and relevant personal information. Descriptive statistics, chi-square, and logistic regression were used in analyzing the data.

Results: There were 145 participants (females 115 (79.3%); physiotherapy (74) 51.03%), making 36.7% of the present undergraduate student population in the two departments. The most prevalent ergonomic work hazards were prolonged sitting (71.7%) and repetitive movements (53.8%). The 12 months prevalence of MSP among the students was 89.7%. The pattern of MSP revealed that pain on the neck region was most prevalent (66.2%) followed by pain in the low back region (64.4%). Duration of daily travels and participation in regular exercise activities were significantly associated with the prevalence of MSP. Logistic model explained 23.6% of the variance in prevalence of MSP and correctly classified 94.1% of cases (${\chi }^2=13.73$, $p=0.03$). The right-handed students were 0.13 times more likely to present with MSP than left-handed students. Also, students who exercised regularly were 9.47 times less likely to present with MSP.

Conclusion: MSP is highly prevalent among health science undergraduates and is significantly associated with sedentary postures and inadequacy in structured physical activity participation.

Background/Objective: To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.

Methods: Translation was performed from the original English instruction via the recommended “Process of translation and adaptation of instruments” by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.

Results: Intraclass correlation coefficient for inter-rater reliability was excellent ($\mathrm{\text{ICC}}=0.999$, 95% confidence $\mathrm{\text{interval}}=0.996$–1.000). Similarly, the intra-rater reliability across the three raters was high (R1: $\mathrm{\text{ICC}}=0.996$, 95% confidence interval $(\mathrm{\text{CI}})=0.812$–1.000; R2: $\mathrm{\text{ICC}}=1.000$, 95% $\mathrm{\text{CI}}=0.994$–1.000; R3: $\mathrm{\text{ICC}}=1.000$, 95% $\mathrm{\text{CI}}=0.998$–1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption ($r=0.315$, $p=0.023$; $r=0.309$, $p=0.026$).

Conclusion: This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.

Background: Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability.

Objective: This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily ($n=49$).

Methods: All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance.

Results: The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability ($p<0.05$). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance ($\rho =-0.351$ to $-$0.493, $p<0.05$).

Conclusion: The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.

Objective: This study investigated the limits of stability (LOS) and the movement patterns during reaching by applying the Multi-Directional Reach Test (MDRT) in children with Down syndrome (DS) aged 7–12 years old.

Methods: Thirty children with DS and 30 age and gender typical development (TD) matched children, aged 7–12 years old were recruited. Each child was asked to reach as far as possible during standing in four directions using a self-selected movement pattern. The movement patterns were classified by two experienced pediatric physical therapists.

Results: The reach distance in children with DS aged 7–9 years old was significantly shorter than TD children aged 7–9 years old for the forward and backward directions. Also, the reach distance in DS children aged 7–9 years old was significantly smaller than that of TD children aged 10–12 years old for all directions. For children with DS aged 10–12 years old, the reach distance was significantly less than that of TD children only in the backward direction. All children with DS in this study adopt a hip and mixed strategy during forward and backward reaching. In contrast, TD children adopt an adult-like movement pattern.

Conclusion: The boundary of stability in an anteroposterior (AP) direction of children with DS aged 7–12 years old was lesser than the matched TD children, especially for the backward direction. These findings may assist therapists in detecting postural control and balance problems in children with DS.