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Rheumatoid Arthritis (RA) patients present is an increased cardiovascular risk (CVR) linked to systemic inflammatory manifestations. A physical activity program with known positive effects on CVR, followed by cryotherapy because of its analgesic and anti-inflammatory effects, may be interesting. However, there are no reports in the literature of such a program. This study aimed to determine the feasibility (acceptability, safety, and effectiveness) of an individualized Intermittent Exercise Program followed by cold-water immersion as a recovery for RA patients. The program was conducted three times per week by eighteen RA patients (one man) with means of age and BMI of 55 (11.9) years and 25.5 (4.7) kg·m -2 . Outcomes were assessed before and after nine and seventeen sessions and included evaluation of acceptability by perceived exertion (Borg) and water temperature (VAS) measures at each session; safety by a number of painful and swollen joints (echography); physical function (health assessment questionnaire); general health status (Short Form-36) measures; and effectiveness by arterial stiffness (pulse wave velocity, or PWV) measures. The results showed good acceptability of the program; no patient dropped out of the protocol or even presented difficulties or perceived pain. The HR and PWV values decreased significantly (70.2 ± 8.4 to 66 ± 5.5; p < 0.05 and 8.9 ± 1.2 to 7.0 ± 0.8; p < 0.001) after nine exercise sessions. No aggravation of symptoms has been noted. This program is acceptable, safe, and effective; consider tailoring it for supervised home-based use.

Two-thirds of people with Multiple Sclerosis (PwMS) have walking disabilities. Considering the literature, prolonged tests, such as the 6 min walk test, better reflect their everyday life walking capacities and endurance. However, in most studies, only the distance traveled during the 6MWT was measured. This study aims to analyze spatio-temporal (ST) walking patterns of PwMS and healthy people in the 6MWT. Participants performed a 6MWT with measures of five ST variables during three 1 min intervals (initial: 0'-1', middle: 2'30″-3'30″, end: 5'-6') of the 6MWT, using the GAITRite system. Forty-five PwMS and 24 healthy people were included. We observed in PwMS significant changes between initial and final intervals for all ST parameters, whereas healthy people had a rebound pattern but the changes between intervals were rather negligible. Moreover, ST variables' changes were superior to the standard measurement error only for PwMS between initial and final intervals for all ST parameters. This result suggests that the modification in PwMS' walking pattern is effectively due to their walking ability and not to a measurement, and suggests that PwMS could not manage their walking efficiently compared to healthy people, who could maintain their rhythm throughout the 6MWT. Further studies are needed to detect these patterns changes in the early evolution of the disease, identify clinical determinants involved in PwMS' walking pattern, and investigate whether interventions can positively impact this pattern.

Gait disorders can be disabling in persons with multiple sclerosis (PMS). Different gait parameters have been used to evaluate gait disorders according to the International classification of functioning. Some authors have reported a direct relation between evaluations over short distances and long-term outcomes. This relationship is of interest for the purposes of clinical research, as it enables short-distance evaluations to be used as a primary endpoint for trials. However, these endpoints are not always particularly relevant for PMS, and furthermore, all evaluations do not present the same metrological characteristics, especially with regards to reproducibility. However, it is essential to have good reproducibility in order to be able to test the effect of a therapeutic strategy on walking parameters in PMS. Using a range of walk tests (timed 25-foot walk in different conditions, namely comfortable walking, fast walking and dual-task walking; the Timed Up and Go test; the 6minute walk test) associated with neuromotor analysis of the lower limbs, we describe the advantages and limitations of gait evaluation in MS. Based on clinical experience accumulated over 4 years, we propose a minimum set of measurements to be used in clinical practice and also for research purposes., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Gait limitation is one of the most common disabilities in people with multiple sclerosis (MS). Several studies have used gait parameters to determine the effects of different therapies. However, few studies have determined their reproducibility, also the therapeutic effects could be overestimated., Research Question: To examine the reproducibility in gait measurements during short and long distances., Methods: In this cross-sectional study we recruited a group of MS patients and compare it to a control group. The participants performed the following tests in a fixed order: a 25-foot walk at a comfortable speed, at a fast speed and during a dual task, a timed up-and-go test (TUG) and a six- minute walk test (6MWT). Two measurements were conducted a week apart. Systematic error was evaluated by the Student t-test, reliability by the intra-class correlation coefficients (ICC) and agreement by the minimum detectable change (MDC 95 )., Results: A total of 58 people with MS and 19 healthy people were included. The absence of systematic error was only found for the fast speed condition. The reliability of the gait parameters had moderate to high ICC values (ICC > 0.7) except for the dual task cost (DTC) which was 0.45. The MDC 95 was higher in people with MS compared to healthy people, and it was higher in people with MS for gait speeds in all conditions (> 34%). For the TUG and 6MWT, the MDC 95 were 51.5% and 31.7% respectively. For people with MS the smallest MDC 95 was found for the stance time for all conditions (6.8%), whereas the highest was found for the dual task cost (158.7%)., Significance: The MDC 95 values were higher than the cut-off point based on the minimally important clinical difference (MICD) proposed in previous studies. Thus, the MDC 95 should be used as a cut-off rather than MICD values., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction: Rheumatoid arthritis (RA) is an autoimmune, chronic and inflammatory disease, which the affected patients present a higher cardiovascular mortality rate. Physical activities have been identified as the most important strategy to prevent cardiovascular diseases. However, the articular damage and the chronic pain caused by RA challenges its regular practice. Moreover, persons with RA tend to avoid PA due to the fear of exacerbating the inflammatory potential and pain. One alternative to avoid the collateral effects of the PA could be the cryotherapy. Therefore, this study aimed to review studies focused on the use of both PA and cryotherapy in RA patients and to identify evidences that both therapies could be combined in order to optimize the symptomatic treatment., Evidence Acquisition: Four databases (MEDLINE, CINAHL, Elsevier and PEDro) were searched to identify publications regarding RA patients, PA and cryotherapy intervention by the terms and operators (rheumatoid arthritis AND exercise OR physical activity OR activity OR training OR reconditioning OR cryotherapy OR cold OR immersion). The selected studies should at least present one measure of the aerobic capacity, disease activity or pain relief. Among 19 studies with RA patients identified, only 4 studies used PA combined with cryotherapy. The other 13 studies used physical activities and 2 studies used cryotherapy intervention., Evidence Synthesis: The results of the physical activities combined with cryotherapy studies showed an improvement in the disease activity and pain relief, however without details of the physical activities intervention and an aerobic capacity. Among the physical activities studies, evidence was found suggesting that aerobic exercises and multiactivity exercises with high intensity are the more effective for improve the aerobic capacity., Conclusions: Even if few studies on cryotherapy were found, there are enough evidences in the literature that demonstrate the benefits of this intervention on pain relief and disease activity. In summary, neither study found associated physical activities to improve aerobic capacity with cryotherapy to improve disease activity and pain relief. This may be an innovative therapeutic strategy to improve the aerobic capacity in arthritis patients and consequently reduce their cardiovascular risk while minimizing pain and disease activity.

Background: The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA)., Methods: Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m 2 ) and obese patients (BMI ≥30 kg/m 2 ) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement., Results: At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011)., Conclusion: These findings show that all patients improved biomechanically and clinically, regardless of their BMI., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to describe the evolution of kinematic and clinical outcomes of a large patient cohort with knee osteoarthritis from before surgery (V1) to 3 months (V2) and 1 year (V3) after a total knee arthroplasty (TKA)., Methods: The patients were evaluated at each visit (118 patients at V1, 93 patients at V2, and 79 patients at V3) during a clinical gait analysis and were compared with a matched control group of healthy adults (CG). The kinematic parameters, the Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Gait velocity and knee range of motion (ROM) as well as clinical parameters were compared at each visit with CG was based on the unpaired samples t-test. To determine changes in the data at baseline, 3 months, and 1 year after surgery in the patient groups, repeated-measure analysis of variance was conducted (P < .05). Pearson correlation was used to examine relationships between clinical and biomechanical outcomes., Results: One year after TKA (V3) compared to V1 and V2, the ROM of the operated knee during gait was significantly improved (V1: 44.2 ± 8.8° vs V3: 47.5 ± 7.1°, P < .001, and V2: 42.2 ± 9.3° vs V3: 47.5 ± 7.1°, P = .001), as was the gait velocity (V1: 1.0 ± 0.2 and V2: 1.1 ± 0.2 m/s vs V3: 1.3 ± 0.2 m/s, P < .001). The WOMAC and knee pain were significantly better 1 year after TKA. No strong relationships have been found between clinical parameters and knee kinematics., Conclusion: This study showed that 1 year after TKA, patients exhibited improved gait velocity and ROM and experienced a significant decrease in the level of pain and an increased clinical score (although different from CG)., (Copyright © 2016. Published by Elsevier Inc.)

Background: Fampridine improves walking in patients with multiple sclerosis (pwMS). However, little is known about its impact on the quality of life (QoL) of pwMS., Objectives: This study aimed to evaluate the contribution of fampridine on the QoL of pwMS and to determine if improvements in QoL are best associated with walk respondents., Methods: Fifty pwMS were included in this study. The PERSEPP scale and the GaitRite system were used to evaluate QoL and gait respectively. QoL was evaluated 7 days before fampridine (Pre1), on the day the fampridine treatment was initiated (Pre2), and 14 and 21 days after fampridine (Post1 and Post2 respectively). Gait was assessed at Pre-1, Pre-2 and Post-1., Results: For all patients, fampridine had significant effects (p = 0.05-10(-4), d = 0.25-0.45) on the Overall, Relationship difficulties, Fatigue, Time perspective and Symptoms QoL indices and for gait parameters (p = 0.05-10(-4), d = 0.17-0.38). Non-respondents scored significant effects (p < 0.05-0.01, d = 0.32-0.41) for Overall, Time perspective and Symptoms QoL indices, whereas respondents scored significant effects (p < 0.05-0.01, d = 0.51-0.8) for Overall, Relationship difficulties, Fatigue and Symptoms., Conclusion: The QoL of pwMS improved after fampridine, suggesting a real benefit in their lives. However, the contributions to the overall QoL index seem different between groups.

The aim of this study was to determine the clinical morbidity and changes in gait temporal spatial parameters after harvesting of a vascularized free fibula flap. This study included 11 patients (mean age: 52 ± 17 years) and 11 healthy controls (mean age: 50 ± 14 years). The patients were assessed between 5 and 104 months post surgery. The study consisted of a subjective functional evaluation with two validated clinical scores (Kitaoka Score and Point Evaluation System (PES) score), clinical and neurological examination of the legs, and evaluation of gait temporal spatial parameters while walking at a comfortable speed. The mean functional Kitaoka score was 78/100, and the mean PES score of 12.18 was considered average. At the time of the review, five patients had sensory disorders, two had toe deformities, and eight had pain at the donor site. The gait analysis showed that the patient's comfortable walking speed was significantly lower in comparison to that of the controls, and that stride length and cadence were reduced. In addition, most of the gait-specific parameters were significantly different. The donor leg displayed greater variability during walking. To reduce the risk of falling, this study revealed that the patients' gait pattern had changed as they took a more cautious approach during walking. Early rehabilitation is expected to help improve and/or restore the physical abilities of patients after harvesting of the vascularized free fibula flap., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate whether clinical parameters are sufficient using, a multilinear regression model, to reproduce the sagittal plane joint angles (hip, knee, and ankle) in cerebral palsy gait. A total of 154 patients were included. The two legs were considered (308 observations). Thirty-six clinical parameters were used as regressors (range of motion, muscle strength, and spasticity of the lower). From the clinical gait analysis, the joint angles of the sagittal plane were selected. Results showed that clinical parameter does not provide sufficient information to recover joint angles and/or that the multilinear regression model is not an appropriate solution.

Background: Previous studies have demonstrated balance impairment in patients with knee osteoarthritis (OA). Although it is currently accepted that postural control depends on multi-joint coordination, no study has previously considered this postural strategy in patients suffering from knee OA. The objectives of this study were to investigate the multi-joint postural behavior in patients with knee OA and to evaluate the association with clinical outcomes., Methods: Eighty-seven patients with knee OA and twenty-five healthy elderly were recruited to the study. A motion analysis system and two force plates were used to investigate the joint kinematics (trunk and lower body segments), the lower body joint moments, the vertical ground reaction force ratio and the center of pressure (COP) during a quiet standing task. Pain, functional capacity and quality of life status were also recorded., Results: Patients with symptomatic and severe knee OA adopt a more flexed posture at all joint levels in comparison with the control group. A significant difference in the mean ratio was found between groups, showing an asymmetric weight distribution in patients with knee OA. A significant decrease in the COP range in the anterior-posterior direction was also observed in the group of patients. Only small associations were observed between postural impairments and clinical outcomes., Conclusion: This study brings new insights regarding the postural behavior of patients with severe knee OA during a quiet standing task. The results confirm the multi-joint asymmetric posture adopted by this population., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background/aims: Fampridine is sometimes reported to improve cognition and especially the information-processing speed. Motor improvement might be a confounding factor. The aim of this study was to evaluate the effects of fampridine on verbal fluencies in patients with multiple sclerosis (MS)., Methods: Fifty MS patients were included in a prospective monocentric open label trial with a mean Expanded Disability Status Scale of 5.3 ± 1.1. Assessments of verbal phonological and semantic fluencies were repeated twice (within 1 week) before fampridine treatment and twice after fampridine treatment in order to have the maximal practice effect. Gait velocity and fatigue (visual analogical scale) were also assessed. Distribution into gait responders, gait non-responders, fluency responders and fluency non-responders, was described., Results: Verbal fluencies were significantly higher after fampridine treatment. No correlation was observed between phonological fluency improvement and semantic fluency improvement. Gait responders and gait non-responders did not present significant differences in verbal fluency performance and fatigue score. No correlation between gait velocity improvement and fatigue improvement compared with verbal fluency improvement was observed., Conclusion: Our results suggest that fampridine could have a selective procognitive effect on phonological fluency in MS, even in the gait non-responder patients., (© 2015 S. Karger AG, Basel.)

The objective of this study was to investigate how gait and clinical outcomes contribute to patients' satisfaction three months following a total knee arthroplasty (TKA). Seventy-eight patients with knee osteoarthritis (OA) and a control group of twenty-nine subjects were evaluated. The gait parameters, Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and functional levels, quality of life and patients' satisfaction following TKA were assessed. A multiple linear regression model shows that the WOMAC functional score explained 39% of the global satisfaction and 37% of the satisfaction related to pain relief following TKA. Finally, the model shows that 65% of the satisfaction related to the functional improvement was explained by a combination of clinical and gait parameters. This study demonstrated the contribution of both gait and clinical outcomes to patients' satisfaction following TKA., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To compare the well-recognized solid ankle cushion heel (SACH) foot with the prosthetic foot developed by the International Committee of the Red Cross (CR Equipements SACH) during gait., Design: Double-blind study was conducted to compare the influence on the biomechanics of gait of the CR Equipements SACH foot and the SACH foot., Setting: University hospital research center., Participants: Participants with unilateral transtibial amputation (N=15) were included., Interventions: Three-dimensional motion analysis system and 2 forceplates were used to capture body motion and ground reaction forces during gait at a self-selected speed and at 1.2m/s., Main Outcome Measures: Nonparametric Wilcoxon matched-pairs tests were used to compare the 2 prosthetic feet with respect to their spatiotemporal (gait velocity, stride length, and percentage of stance phase), kinematic (range and peak angles of the pelvis, hip, knee, and ankle), and kinetic (peak moment and power of the hip, knee, and ankle) parameters., Results: Compared with the SACH foot, the CR Equipements SACH foot demonstrated a significantly greater stance phase symmetry ratio (SACH: 94% vs CR Equipements SACH: 97%), a more extensive ankle range of motion in the sagittal plane (SACH: 7° vs CR Equipements SACH: 12°), a greater maximal dorsiflexion angle during the terminal stance phase (SACH: 10° vs CR Equipements SACH: 13°), and a higher ankle power (SACH: .31W/kg vs CR Equipements SACH: .40W/kg). No significant difference was found for the examined knee, hip, and pelvis parameters., Conclusions: The CR Equipements SACH foot provides more symmetry and improves ankle kinematics and kinetics in the sagittal plane compared with the SACH foot. This study suggests that individuals using the CR Equipements SACH foot improve their gait biomechanics compared when using the SACH foot., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: From a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy., Design: A retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009., Population: One hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study., Method: Quinlan's Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity)., Results: Seven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments., Conclusion: There is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Given the complexity of the gait of patients with knee osteoarthritis, a multiple correspondence analysis may be helpful to optimise the extraction of relevant gait and clinical information. Therefore, the aims of this study are to identify the main associations with clinical and gait biomechanical parameters and to evaluate whether there are more specific knee osteoarthritis groups with different gait profiles., Methods: Ninety patients with severe knee osteoarthritis and twenty-six healthy individuals participated in this study. Pain and function were assessed with the WOMAC Index; knee joint deformity was assessed by the hip-knee-ankle angle on full-limb radiography; and full body gait analysis was performed with a motion analysis system and force plates., Findings: Using multiple correspondence analysis, two categories of gait parameters that best explain the gait variance of patients with knee osteoarthritis were highlighted. The forward displacement category is composed of the parameters speed, stride length, hip flexion and knee flexion. The frontal category is composed of the parameters thorax obliquity and knee adductor moments. Moreover, based on these parameters, four distinct gait profiles were identified: two gait profiles were associated with knee varus deformities, increased thorax obliquity and different forward displacements, while two gait profiles were associated with valgus deformities and different forward displacements., Interpretation: These gait parameters can be used to simplify the characterisation of the gait of the knee osteoarthritis population. Patients in varus profiles increase thorax obliquity on the stance limb and may reduce forward displacement. Patients in valgus profiles, however, only reduce forward displacement., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this systematic review was to identify which biomechanical and physiological parameters are the most relevant, commonly used, able to discriminate and/or have specific clinical relevance for the gait analysis of lower-limb amputees (LLA)., Methods: We performed an electronic search via the PubMed, EMBASE and ISI Web of Knowledge databases from 1979 to May 2009. Two independent reviewers assessed the title and abstract of each identified study. The quality assessment of the full text was undertaken using a 13-item checklist divided into three levels: A, B, and C., Results: The literature search identified 584 abstracts to be considered. After applying the inclusion criteria, we reviewed the full text of a total of 89 articles. The mean article quality was 8±2. No A-level article was found; the primary reason was a negative score in blinded outcome assessment. Sixty-six articles (74%) corresponded to a B-level, and two articles (2%) corresponded to a C-level. Twenty-one articles (24%) did not acquire enough points to be assigned to any level. In this study, we present and discuss the most commonly used and most relevant 32 parameters. Many of the parameters found were not reported in enough studies or in enough detail to allow a useful evaluation., Conclusion: This systematic review can help researchers compare, choose and develop the most appropriate gait evaluation protocol for their field of study, based on the articles with best scores on the criteria list and the relevance of specific biomechanical and physiological parameters., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: To verify whether additional manual wheelchair mass above a critical level would produce, during many daily tasks, an increase in physiologic parameters, an increase in the perceived exertion, and a decrease in performance., Design: A repeated-measurement design., Setting: Six standardized tests thought to mimic daily activities., Participants: Volunteers (N=21), 8 men with spinal cord injuries (SCIs; mean age, 34+/-12y; range, 19-56y) and 13 able-bodied persons (11 men and 2 women; mean, 24+/-5y; range, 18-37y)., Interventions: Random additional masses ("0", 1, 2, 5kg) were placed under the seat of a multisport manual wheelchair (mass approximately 10kg) out of the subject's field of vision., Main Outcome Measures: Energy expenditure (EE; total o(2) consumed), heart rate (total number of beats), perceived exertion (visual analog scale), and performance (seconds to execute a sprint test) were measured., Results: For all tests, there was no significant effect of mass found for either group for the EE, heart rate, and performance. In addition, for all tests, no significant effect of mass was found for the SCI group for the visual analog perceived exertion. However, for the able-bodied group, the added mass had a significant effect for the visual analog perceived exertion (F=6.11; P=.02) in the Stop-and-Go test. A post hoc Tukey test showed a significant difference between the 0kg and 5kg mass conditions (P<.01; d=.8), between 1kg and 5kg (P=.02; d=.6), and between 2kg and 5kg (P=.01; d=.6)., Conclusions: Based on these findings, it can be concluded that, under the conditions of this study, additional mass (up to 5kg) loaded on a multisport manual wheelchair does not seem have any effect on EE, heart rate, or performance and has a minor effect on the visual analog perceived exertion evaluated in many activities of daily living.