FOTO - Focus on Therapeutic Outcomes | Gait Archives https://fotoinc.com/tag/gait/ Measure Outcomes - Manage Quality - Market Strengths Tue, 15 Feb 2022 14:44:56 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.2 A Functional Limitation to the Lower Limbs Affects the Neural Bases of Motor Imagery of Gait https://fotoinc.com/foto-blog/a-functional-limitation-to-the-lower-limbs-affects-the-neural-bases-of-motor-imagery-of-gait/?utm_source=rss&utm_medium=rss&utm_campaign=a-functional-limitation-to-the-lower-limbs-affects-the-neural-bases-of-motor-imagery-of-gait https://fotoinc.com/foto-blog/a-functional-limitation-to-the-lower-limbs-affects-the-neural-bases-of-motor-imagery-of-gait/#respond Mon, 01 Oct 2018 10:00:00 +0000 https://fotoinc.com/a-functional-limitation-to-the-lower-limbs-affects-the-neural-bases-of-motor-imagery-of-gait/ You provide care for quite a few people who have knee pain. Sometimes you see these patients before surgery – other times after surgery. When someone has persistent knee pain, what is something you typically note during your examination? For me, most of my patients who are receiving services for long standing pain in their […]

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]]> You provide care for quite a few people who have knee pain. Sometimes you see these patients before surgery – other times after surgery. When someone has persistent knee pain, what is something you typically note during your examination?

role-of-motor-imagery-and-functional-limitations-lower-extremity

For me, most of my patients who are receiving services for long standing pain in their knee tend to have gait abnormalities. Sometimes their gait is slow…. sometimes they have an obvious limp. My role is not only to help with their pain experience, but to also improve their level of function.

What this study is so great at outlining is the neuroplasticity of the brain. Those who have long standing gait abnormalities demonstrate changes in their brain to such a degree that the brain no longer has the capability to imagine a normal movement pattern. 

This means that motor imagery will not be the best cognitive tool in your box. Your brain will do better with visual imagery – where the patient watches the desired activity. This makes sense because when I ask patients to think about a particular movement and how it feels, it’s almost as though they have a disconnect. If I use a video or my hands… or even what my patients call my “Stride Rite” treadmill, they immediately understand and are able to attempt to change their preferred, learned over time, movement patterns.

This research may also help explain why after a person has surgery and no longer has pain that the abnormal gait characteristics persist. The neuroplasticity of the brain created new movement maps and maintained that map, even after surgery and pain relief.

You’ll find the abstract to the recent study below.

A functional limitation to the lower limbs affects the neural bases of motor imagery of gait.

Sacheli LM1,2, Zapparoli L2, Preti M2, De Santis C1, Pelosi C2, Ursino N2, Zerbi A2, Stucovitz E2, Banfi G2,3, Paulesu E1,2.

 

Abstract

Studies on athletes or neurological patients with motor disorders have shown a close link between motor experience and motor imagery skills. Here we evaluated whether a functional limitation due to a musculoskeletal disorder has an impact on the ability to mentally rehearse the motor patterns of walking, an overlearned and highly automatic behaviour.

We assessed the behavioural performance (measured through mental chronometry tasks) and the neural signatures of motor imagery of gait in patients with chronic knee arthrosis and in age-matched, healthy controls. During fMRI, participants observed (i) stationary or (ii) moving videos of a path in a park shown in the first-person perspective: they were asked to imagine themselves (i) standing on or (ii) walking along the path, as if the camera were “their own eyes” (gait imagery (GI) task). In half of the trials, participants performed a dynamic gait imagery (DGI) task by combining foot movements with GI.

Behavioural tests revealed a lower degree of isochrony between imagined and performed walking in the patients, indicating impairment in the ability to mentally rehearse gait motor patterns. Moreover, fMRI showed widespread hypoactivation during GI in motor planning (premotor and parietal) brain regions, the brainstem, and the cerebellum. Crucially, the performance of DGI had a modulatory effect on the patients and enhanced activation of the posterior parietal, brainstem, and cerebellar regions that the healthy controls recruited during the GI task.

These findings show that functional limitations of peripheral origin may impact on gait motor representations, providing a rationale for cognitive rehabilitation protocols in patients with gait disorders of orthopaedic nature. The DGI task may be a suitable tool in this respect.

 2018 Jul 5;20:177-187. doi: 10.1016/j.nicl.2018.07.003. eCollection 2018.

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]]> https://fotoinc.com/foto-blog/a-functional-limitation-to-the-lower-limbs-affects-the-neural-bases-of-motor-imagery-of-gait/feed/ 0 Smart Phone Virtual Reality and Postural Stability Challenge https://fotoinc.com/foto-blog/smart-phone-virtual-reality-and-postural-stability-challenge/?utm_source=rss&utm_medium=rss&utm_campaign=smart-phone-virtual-reality-and-postural-stability-challenge https://fotoinc.com/foto-blog/smart-phone-virtual-reality-and-postural-stability-challenge/#respond Mon, 06 Aug 2018 10:00:00 +0000 https://fotoinc.com/smart-phone-virtual-reality-and-postural-stability-challenge/ Organizational rules that disallow a smart phone to be available on person during the clinical day eliminates the opportunity for many clinicians to utilize technology. My cell phone and iPad are readily available for my use during my clinic days. Amazing applications have influenced my practice: from wellness apps that motivate patients to be physically […]

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]]> Organizational rules that disallow a smart phone to be available on person during the clinical day eliminates the opportunity for many clinicians to utilize technology.

virtual-reality-postural-stability

My cell phone and iPad are readily available for my use during my clinic days. Amazing applications have influenced my practice: from wellness apps that motivate patients to be physically active to apps that provide safe and challenging balance activities for patients. I also have apps that help me immediately know lab values and their meaning and apps that help me know the sensitivity, specificity and likelihood ratios of clinical tests. Smart phones are quite the amazing resource.

Truth be told, I am wrestling with virtual reality. I have played with a system and I can see opportunity for clinical value. I’m a bit of a germaphobe – well, not really a strong germaphobe – but on a practical, reasonable side of it. Wearing devices means that I need to ensure that I’m not cross contaminating patients. I’m really not sure the best way to ensure cleanliness between patients when it comes to virtual reality.

What excites me is that there are fun and cheap ways to challenge patients through the use of virtual reality. Maybe we’ll all need to have a cheap supply of ski caps in the clinic in the future as a way to ensure cleanliness between patients? 

You’ll find the abstract to the recent study below.

Smartphone virtual reality to increase clinical balance assessment responsiveness.

Rausch M1, Simon JE1, Starkey C1, Grooms DR2.

 

Abstract

OBJECTIVE:

To determine if a low cost smartphone based, clinically applicable virtual reality (VR) modification to the standard Balance Error Scoring System (BESS) can challenge postural stability beyond the traditional BESS.

DESIGN:

Cross-sectional study.

SETTING:

University research laboratory.

PARTICIPANTS:

28 adults (mean age 23.36 ± 2.38 years, mean height 1.74 m ± 0.13, mean weight 77.95 kg ± 16.63).

MAIN OUTCOME MEASURES:

BESS postural control errors and center of pressure (CoP) velocity were recorded during the BESS test and a VR modified BESS (VR-BESS). The VR-BESS used a headset and phone to display a rollercoaster ride to induce a visual and vestibular challenge to postural stability.

RESULTS:

The VR-BESS significantly increased total errors (20.93 vs. 11.42, p < 0.05) and CoP velocity summed across all stances and surfaces (52.96 cm/s vs. 37.73 cm/s, p < 0.05) beyond the traditional BESS.

CONCLUSION:

The VR-BESS provides a standardized, and effective way to increase postural stability challenge in the clinical setting. The VR-BESS can use any smartphone technology to induce postural stability deficits that may otherwise normalize with traditional testing. Thus, providing a unique relatively inexpensive and simple to operate clinical assessment tool and∖or training stimulus.

 2018 Jul;32:207-211. doi: 10.1016/j.ptsp.2018.05.017. Epub 2018 May 22.

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