III.

Objective To determine whether applying an assistance force to the pelvis and legs during treadmill training can improve walking function in children with cerebral palsy (CP). Design Twenty-three children with CP were randomly assigned to the robotic or treadmill only group. For participants who were assigned to the robotic group, a controlled force was applied to the pelvis and legs during treadmill walking. For participants who were assigned to the treadmill only group, manual assistance was provided as needed. Each participant trained 3 times/week for 6 weeks. Outcome measures included walking speed, 6-minute walking distance, and clinical assessment of motor function, which were evaluated pre, post training, and 8 weeks after the end of training, and were compared between two groups. Results Significant increases in walking speed and 6-minute walking distance were observed after robotic training (p = 0.03), but no significant change was observed after treadmill training only. A greater increase in 6-minute walking distance was observed after robotic training than that after treadmill only training (p = 0.01). Conclusions Applying a controlled force to the pelvis and legs, for facilitating weight-shift and leg swing, respectively, during treadmill training may improve walking speed and endurance in children with CP.

Objective To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals poststroke. Design Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups. Setting Research units of rehabilitation hospitals. Participants Patients (N=30) with chronic stroke. Intervention Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking. For the assistance group, a load that assists swing was applied. Main Outcome Measures Primary outcome measures were walking speed and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and quality of life. Outcome measures were evaluated before and after 6 weeks of training and at 8 weeks’ follow-up, and compared within group and between the 2 groups. Results After 6 weeks of robotic training, walking speed significantly increased for both groups, with no significant differences in walking speed gains observed between the 2 groups. In addition, 6-minute walking distance and balance significantly improved for the assistance group but not for the resistance group. Conclusions Applying a controlled resistance or an assistance load to the paretic leg during treadmill training may induce improvements in walking speed in individuals poststroke. Resistance training was not superior to assistance training in improving locomotor function in individuals poststroke.

Objective A major barrier to reducing falls among users of lower limb prostheses (LLP) has been an absence of statistical indices required for clinicians to select and interpret scores from performance-based clinical tests. The study aimed to derive estimates of reliability, measurement error, and minimal detectable change values in performance-based clinical tests administered to unilateral LLP users. Methods A total of 60 unilateral LLP users were administered the Narrowing Beam Walking Test, Timed ``Up and Go'' (TUG), Four Square Step Test (FSST), and 10-Meter Walk Test on 2 occasions, 3 to 9 days apart. Intraclass correlation coefficients (ICCs) were calculated to assess interrater and test-retest reliability, while standard error of measurement (SEM) and minimal detectable change (MDC90) were derived to establish estimates of measurement error in individual scores or changes in score for each test. Results Interrater reliability ICCs (1,1) were high for all tests (ie, ≥0.98). Test-retest ICCs (2,1) varied by test, ranging from .88 for the TUG to .97 for the FSST. SEM and MDC90 varied between .39 and .96 and between .91 seconds and 2.2 seconds for the time-based tests (FSST, TUG, 10-Meter Walk Test). SEM and MDC90 for the Narrowing Beam Walking Test were .07 and .16, respectively. Conclusion With the exception of the TUG, studied tests had test-retest ICCs (2,1) that exceeded the minimum required threshold to be considered suitable for group- and individual-level applications (ie, ICC ≥ 0.70 and ≥ 0.90, respectively). Future research on individuals with dysvascular and transfemoral amputations or in specific age categories is required. Impact Along with published validity indices, these reliability, error, and change indices can help clinicians select balance tests suitable for LLP users. They can also help clinicians interpret test scores to make informed, evidence-based clinical decisions.