Background and Purpose. People with stroke are at risk for falls. The purpose of this study was to estimate the strength of the relationship of balance and mobility to falls. Subjects. The participants were 99 community-dwelling people with chronic stroke. Methods. An interview was used to record fall history, and physical performance assessments were used to measure balance (Berg Balance Scale [BBS]) and mobility (gait speed). Results. No differences were found between subjects who fell once and subjects who did not fall or between subjects who fell more than once and subjects who did not fall. Neither balance nor mobility was able to explain falls in people with chronic stroke. Discussion and Conclusion. Clinicians should be cautious when using the BBS or gait speed to determine fall risk in this population. Falls occurred frequently during walking; it may be necessary to focus on reactive balance and environmental interaction when assessing individuals for risk of falls and devising fall prevention programs for individuals with chronic stroke. The authors' observations suggest that the prescription of 4-wheel walkers for individuals with a low BBS score (≤45) may be a mobility aid that could reduce the risk of falls.

Study design: Systematic review. Objectives: To systematically review the psychometric properties of outcome measures used to assess ambulation in people with spinal cord injury (SCI). Setting: Vancouver, BC, Canada. Methods: A keyword literature search of original articles that evaluated the psychometric properties of ambulation outcome measures in the SCI population was conducted using multiple databases. Multidimensional scales of function were included if specific data were available on ambulation-related subscales. Reliability, validity and responsiveness values were extracted and conclusions drawn about the psychometric quality of each measure. Results: Seven outcome measures were identified and were broadly categorized into timed and categorical measures of ambulation. Timed measures included timed walking tests that showed excellent reliability, construct validity and responsiveness to change. The psychometric properties of the categorical scales were more variable, but those that were developed specifically for the SCI population had excellent reliability and validity. Categorical scales also exhibited some floor or ceiling effects. Conclusion: Excellent tools are available for measuring functional ambulation capacity. Further work is required to develop and evaluate outcome measures to include environmental factors that contribute to the ability to achieve safe, functional ambulation in everyday settings. Sponsorship: Rick Hansen Man-in-Motion Foundation and Ontario Neurotrauma Fund.

Powered robotic exoskeletons are a potential intervention for gait rehabilitation in stroke to enable repetitive walking practice to maximize neural recovery. As this is a relatively new technology for stroke, a scoping review can help guide current research and propose recommendations for advancing the research development. The aim of this scoping review was to map the current literature surrounding the use of robotic exoskeletons for gait rehabilitation in adults post-stroke. Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of Clinical Trials) were searched for articles from inception to October 2015. Reference lists of included articles were reviewed to identify additional studies. Articles were included if they utilized a robotic exoskeleton as a gait training intervention for adult stroke survivors and reported walking outcome measures. Of 441 records identified, 11 studies, all published within the last five years, involving 216 participants met the inclusion criteria. The study designs ranged from pre-post clinical studies (n = 7) to controlled trials (n = 4); five of the studies utilized a robotic exoskeleton device unilaterally, while six used a bilateral design. Participants ranged from sub-acute (<7 weeks) to chronic (>6 months) stroke. Training periods ranged from single-session to 8-week interventions. Main walking outcome measures were gait speed, Timed Up and Go, 6-min Walk Test, and the Functional Ambulation Category. Meaningful improvement with exoskeleton-based gait training was more apparent in sub-acute stroke compared to chronic stroke. Two of the four controlled trials showed no greater improvement in any walking outcomes compared to a control group in chronic stroke. In conclusion, clinical trials demonstrate that powered robotic exoskeletons can be used safely as a gait training intervention for stroke. Preliminary findings suggest that exoskeletal gait training is equivalent to traditional therapy for chronic stroke patients, while sub-acute patients may experience added benefit from exoskeletal gait training. Efforts should be invested in designing rigorous, appropriately powered controlled trials before powered exoskeletons can be translated into a clinical tool for gait rehabilitation post-stroke.

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Paretic upper-limb strength had the strongest relationship with variables of activity and best explained upper-limb performance in activities of daily living. Grip strength, tone, and sensation also were factors of upper-limb performance in activities of daily living. Increased tone and upper-limb performance in activities of daily living had a weak relationship with participation.

Study design: Prospective analysis of relationships. Objectives: (1) To quantify the relationship between individual lower extremity muscle strength and functional walking measures and (2) to determine whether a multiple regression model incorporating lower extremity muscle strength could predict the performance of functional walking measures in persons with incomplete spinal cord injury (ISCI) living in the community. Setting: Tertiary rehabilitation center, Vancouver, Canada. Methods: In all, 22 subjects with ISCI participated. The relationship between functional walking measures (gait speed, 6-min-walk distance, and ambulatory capacity) and muscle strength (manual tests of hip flexors/extensors/abductors, knee flexors/extensors, ankle dorsiflexors/plantarflexors, and great toe extensors) were measured by Pearson's correlation and regression procedures. Results: For both the more and less affected sides, hip flexors, hip extensors, and hip abductors produced the highest correlations with the three functional measures. The less affected hip flexor strength explained more than 50% of the variance in gait speed and 6-min-walk distance while the less affected hip extensor strength explained up to 64% of the variance in ambulatory capacity. For all three functional measures, the strength of the less affected limb was more important than that of the more affected limb. Conclusions: Lower extremity muscle strength, in particular that of hip flexors, hip extensors, and hip abductors, is an important determinant of functional walking performance.

Objective: To assess the efficacy of a progressive aerobic exercise training program on cognitive and everyday function among adults with mild subcortical ischemic vascular cognitive impairment (SIVCI).Methods: This was a proof-of-concept single-blind randomized controlled trial comparing a 6-month, thrice-weekly, progressive aerobic exercise training program (AT) with usual care plus education on cognitive and everyday function with a follow-up assessment 6 months after the formal cessation of aerobic exercise training. Primary outcomes assessed were general cognitive function (Alzheimer Results: Seventy adults randomized to aerobic exercise training or usual care were included in intention-to-treat analyses (mean age 74 years, 51% female, n 5 35 per group). At the end of the intervention, the aerobic exercise training group had significantly improved ADAS-Cog performance compared with the usual care plus education group (21.71 point difference, 95% confidence interval [CI] 23.15 to 20.26, p 5 0.02); however, this difference was not significant at the 6-month follow-up (20.63 point difference, 95% CI 22.34 to 1.07, p 5 0.46). There were no significant between-group differences at intervention completion and at the 6-month follow-up in EXIT-25 or ADCS-ADL performance. Examination of secondary measures showed between-group differences at intervention completion favoring the AT group in 6-minute walk distance (30.35 meter difference, 95% CI 5.82 to 54.86, p 5 0.02) and in diastolic blood pressure (26.89 mm Hg difference, 95% CI 212.52 to 21.26, p 5 0.02). Conclusions:This study provides preliminary evidence for the efficacy of 6 months of thriceweekly progressive aerobic training in community-dwelling adults with mild SIVCI, relative to usual care plus education. ClinicalTrials.gov identifier: NCT01027858.Classification of evidence: This study provides Class II evidence that for adults with mild SIVCI, an aerobic exercise program for 6 months results in a small, significant improvement in ADAS-Cog performance. Vascular cognitive impairment (VCI) is the second most common cause of dementia after Alzheimer disease (AD).1 Cerebral small vessel disease plays a critical role in covert ischemia and the development of sub-cortical ischemic vascular cognitive impairment (SIVCI), 2 the most common form of VCI. SIVCI is defined by the presence of white matter lesions (WMLs) and lacunar infarcts, and has the clinical consequence of increased dementia risk.3,4 Aerobic exercise

Considering the many reported benefits of standing, this activity may be useful for people with SCI. This study identified a number of body systems and functions that may need to be investigated if clinical trials of prolonged standing in people with SCI are undertaken.