RESEARCH ARTICLES

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Based on measured improvement in walking speed and stride length, our findings provide evidence that regular use of the Vizziq Neuromuscular Trainer is superior to regular walking practice as a means of improving walking patterns in older adults; eliciting improvements that persist even when walking without the device. We suggest that preventative gait training with the Vizziq NT could reduce fall risk and the need for conventional mobility devices in older adults.

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This study compared changes in gait patterns and walking speed over 3 weeks of training with a novel gait training device (Vizziq Neuromuscular Trainer) to changes observed in women 55 and older walking an equivalent amount without the device.

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This study measured gait variables while using a novel gait training device (Vizziq Neuromuscular Trainer) compared against a 2-wheel and 4-wheel conventional walkers in older (65yr+) adults who were not regular assistive device users. Specific gait variables measured were those associated with risk of falls, including self-selected speed, stride length, double support-time, and gait cycle symmetry. 


In a cross-sectional study of healthy older adults (65+; n=18), participants completed three supervised walking trials under four conditions: normal walking, 2-wheel walker, 4-wheel walker, and gait training device. Data on speed, stride length, pelvic rotation, and gait symmetry (similarity of trunk accelerations on the left and right sides) were assessed using an inertial sensor placed on the low back.

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"The #1 secret to ensuring you stay strong and independent longer? Walk this way." A study in Italy showed that 1/3 of those between 60 and 97 years old had gait disorders, many of which were related to neurological conditions like Parkinson's and dementia.

Learn how Walking Differently May Reduce an Onset of Arthritis and Increase Your Willingness to Exercise. Use this article to perform a gait self-assessment or ask your healthcare provider or physical therapist for an assessment and exercise program that is right for you.

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FORGET THE GYM: WHY A BRISK WALK IS REALLY A GREAT WORKOUT

Simply walking can help you lose weight without changing other lifestyle habits. "Walking is a wonderful alternative to other forms of complex aerobic exercise routines that can be done without the cost of an expensive gym membership. It is free, enjoyable, and already a part of everyday life. All you need to do is correct your technique, walk faster, and for longer and you will lose weight," says Lucy Knight, a personal trainer and author. Use this article to determine the workout plan specific to your current fitness level, help to set your goals, and proper gait mechanics.

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Implementing neuromuscular training into your coaching drills has the potential to both improve strength, but also reduce the number of acute and chronic injuries for your athletes. Dr. Michele LaBotz, a sports medicine physician, emphasizes, "A lot of times when we think about conditioning, we think about traditional strength and endurance, but integrated neuromuscular training is really about teaching quality of movement rather than amount of movement or strength of movement." Check out what the American Academy of Pediatrics (AAP) recommends for implementing neuromuscular training into your everyday coaching to benefit your athelte's health.

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Watch this video with Dr. Peggy Mason, from the University of Chicago about the walking cycle.

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Have you recently noticed that your patient has lost balance or mobility while walking? With aging, we typically see a decline in balance and mobility; therefore, the exercises you conduct with your patient are important to restore gait confidence. Santé Cares, an organization that specializes in rehabilitation, outpatient therapy, and home health for older adults, lists various targeted exercises to improve your patient's gait. Check out what exercises they recommend to improve muscle strength and stability.

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One of our previous posts discussed the gait cycle and all of the different components required for a confident gait rhythm. There are also many components that can lead to an altered gait rhythm; one of these being a stroke. After experiencing a stroke, many patients suffer from muscle weakness and "abnormal synergistic movement patterns." As a therapist, working with a stroke patient requires a highly individualized program, depending on the patient's current movement pattern and any compensatory movements. Therapy includes going back to a baseline for gait training, strength training, and neuromuscular reeducation. Assistive devices are commonly used for support and reeducation during this process. Read more about the kinematic deviations that occur in the gait of a stroke patient.

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National Today presents the history, timeline, and ways to spread awareness of ALS. In the article, the ALS association is recognized for enhancing the quality of life for individuals with ALS. There is currently no cure for ALS, but those with ALS can have a better quality of life if it is treated at an early stage. The ALS Association has paved the way for research in treatments and possibly, a cure. The month of May, being the month of recognition for ALS, has provided an increase in awareness for charity and investment in research. Spreading awareness for ALS has opened doors for education, funding, and working to find a cure. Check out National Today's website for more information on ALS.

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Stanford Medicine's Abraham Verghese, professor of medicine, talks about the different types of gait he examines while primarily working in a hospital setting. He demonstrates the defining characteristic of each type of gait and discusses the neurologic agent of each. The types of gait he discusses are as follows: hemiplegic gait, Parkinson's gait, cerebellar gait, diplegic gait, myopathic gait, and neuropathic gait. Dr. Verghese says, "It would be a great shame for a patient to come to us with an abnormal gait and for us to send the patient for testing, or consultation when the diagnosis might be fairly evident in the gait" (0:28). Observe the different types of gaits your patient may be demonstrating and learn the underlying causes.

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The University of California, San Francisco Benioff Children’s Hospital, Oakland has a Center for Nature and Health. This program takes children with anxiety, autism, or developmental issues, who live in mainly urban areas with limited access to nature trails, to local parks to embark on nature walks. This program is part of a larger movement physicians are prescribing for both young and older patients. Physicians are prescribing nature walks to help better patient physical and mental health. Physician, Dr. Nooshin Razani, says, “It’s pretty clear that it’s good for you"..."Research suggests living near green space and recreating in nature can improve mental health and reduce the risks of certain physical health conditions, like heart disease. Scientists are still trying to figure out why, but the leading theory is that spending time in nature reduces stress, a state that’s tied to many health problems." Although this is not an alternative to medications, nature can serve its own health benefits. Learn more from TIME’s article.

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Gait deviations are defined as an abnormality in the gait cycle. There are several ways our gaits can become altered, whether from age, neurological conditions, orthopedic problems, or other medical conditions. Physopedia states, "Studies have shown that while 85% of individuals 60-year-old have a normal gait, by the time they reach the age of 85, only 20% maintains normal gait." Treatments range from assistive devices to surgery for knee and hip replacements. Assistive devices aid in balance, but physical therapy also aims to improve balance, strength, flexibility, and prevent falls. Gait training at an early age is crucial to improving balance, neuromuscular re-education, and ultimately, may reduce your risk of falls in the future.

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Understanding the gait cycle comes with its own benefits. This article breaks down the different phases of the gait cycle and what an altered gait looks like. An altered gait is defined as a change in the way you walk. It is important to recognize, analyze, and treat any changes in your gait cycle to eliminate any compensatory movements and ultimately, falls. Recognizing and speaking with a physical therapist may help reduce your future risk of falls. Read more about the gait cycle and different types of altered gait patterns.

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3.9% of the US population older than 18 years of age is projected to have had a stroke by 2030 (Ovbiagele B and colleagues, 2013). "Stroke is a leading cause of long-term disability. Of the individuals who survive, more than 80% have gait impairment that recovers to some extent in the first 2 months after stroke." Gait is a prominent predictor of health and falls.

Researchers are finding that high-intensity gait training is beneficial for stroke patients. On the other hand, traditional, low-intensity rehab that "does not challenge the central nervous system," is suggested to be less likely to improve a patient's health and mobility after stroke. Read more about some recommended rehabilitation programs for your stroke patients.

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In 2013 at the University of Malta, 62 subjects: 31 scoliotic representing the study group (SG), and 31 non-scoliotic representing the control group (CG), were analyzed to see the effect of "Idiopathic Scoliosis on gait, through kinematic, kinetic, and electromyographic (EMG) analysis" (2). Step and stride length were analyzed using the Vicon motion capture system. The step and stride lengths for the SG were significantly lower than the CG. A shorter stride length and longer stride time indicate a slower gait speed. With clinical relevance in mind, swing-to-stance ratios were also measured. Swing-to-stance ratios are used to detect gait deviations. For the SG, swing-to-stance ratios range from "0.696-0.728."
Normative values are "(0.63-0.64)" (5). Therefore, the SG values exceed the normative values. These values are significant because they indicate a slower gait speed. Although research suggests a slower gait speed in patients with scoliosis, every patient is different. Scoliosis does not imply gait impairments. Read more about scoliosis and how your patient may be affected during the gait cycle.

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July is Juvenile Arthritis Awareness Month. Juvenile Idiopathic Arthritis (JIA) is "characterized by chronic swelling, limitation, and painful range of motion (ROM)" in children (38). Children with JIA have altered gait biomechanics, including restricted plantar flexion, knee extension and hip extension. These are most evident during the late stance phase and push-off motions of the gait cycle. With these altered motions, children with JIA will commonly walk in a "flexed 'crouch-like' movement pattern" (52). Research also suggests that JIA causes children to walk with a softer loading pattern, which ultimately decreases gait velocity and ground reaction force. Research suggests that therapeutic intervention can potentially improve gait impairments in children with JIA. Learn more about children with JIA.

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The Vizziq Neuromuscular Trainer has become the new standard of mobility technology. The Vizziq's unique design allows for a pivoting frame, helping utilize trunk rotation and a reciprocating arm swing. Clients have said they feel an engaged core and improved upright posture while walking inside the Vizziq. Its surround-around frame and selective handlebar placement allow for safety and a feeling of security on walks. Walk with confidence and a feeling of security with the Vizziq. Visit our website: Vizziq.com to learn more and read our client testimonials. Vizziq.com

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“Ligamentous ankle injuries are the most common sports trauma, accounting for 10% to 30% of all sports injuries...70% of athletes in certain sports suffer recurrent sprains" (51). Neuromuscular control in lower limb exercise is essential for injury prevention. Willems et al suggests paying "attention to gait patterns and [making] adjustments in foot biomechanics" (52). Similar to this rehabilitation process, researchers have found that "biomechanical abnormalities in gait have been cited as common causes of inversion sprains" (51). This is important for athletes and coaches to recognize. Making sure that athletes have correct foot positioning and training when contacting the ground to prevent future injuries. Recurrent ankle sprains may result in modified gait patterns and an altered connection between the CNS and the injured ankle's muscles and/or nerves. Read more about this 4-Week Neuromuscular Training Program for the Ankle Joint.

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Professor Peggy Mason from the University of Chicago dives into the neurobiology behind central pattern generators. Dr. Mason says, "A central pattern generator is a conceptual term, there is a physical reality to it, but the essential concept is that it is a group of neurons that will produce a movement, and it will produce that movement without any sensory feedback, so no involvement of reflexes" (0:55). While central pattern generators do not require sensory feedback, it is fine-tuned by sensory feedback. As we walk, there is a central pattern generator for each leg during the gait cycle. The proprioception that we receive from our environment will fine-tune our central pattern generators as we walk. Learn more from Dr. Mason about central pattern generators and walking.

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Sosnoff and colleagues research the link between multiple sclerosis (MS) "a disease of the central nervous system" and its influence on the gait cycle. In this study, participants included thirteen patients with MS (PwMS), four males and nine females, with a mean age of 51.5 years. Seven of the participants "were independently ambulatory, four walked with single-point assistance, and two walked with two-point assistance" (145). Participants walked along the GAITRite mat at a comfortable pace for a total of 4 trials. Data recorded includes the FAP score, velocity, stride length, step time, base of support, and time spent in double and single support. A normal FAP score is reported at 95+ and the recorded mean FAP score for this study was 73 +/- 20.8. There was a strong association between FAP scores and "lab-based measures of walking performance," and a moderate to strong association between FAP and "outpatient measures of walking impairment and function" (146). This research suggests that using FAP scores for quantifying gait impairment may prove useful for rehabilitation that works to improve FAP scores, therefore, meaning an improvement in gait.

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THE EFFECTS OF NEUROMUSCULAR TRAINING ON THE GAIT PATTERNS OF ACL-DEFICIENT MEN AND WOMEN

Non-copers are individuals with asymmetrical movement strategies on the uninvolved side during the gait cycle, often times resulting from an ACL rupture. Ligament reconstruction from surgery does not eliminate abnormal movement patterns; instead, it often results in asymmetrical movement patterns. In Norway, they typically delay surgical intervention and alternatively train with strength, agility, and other neuromuscular training programs to aid in an ACL rupture recovery. In fact, "current physical therapy practice guidelines for knee ligament sprains now advise supplementing traditional strength training with neuromuscular training as a means to improve function and mitigate abnormal movement" (2). Perturbation training is a type of training that is designed to strengthen the musculature surrounding the knee to ultimately, improve its dynamic stability. This type of training has "proven successful for high=functioning ACL-injured athletes, or potential copers, to return to sport in the short-term without ligament reconstruction" (2). Read more about this study and how neuromuscular training can aid as a beneficial component in improving movement patterns during the gait cycle for your patients and athletes.

Senior Patient with Walker

17% of falls are caused by gait dysfunctions. Gait dysfunctions are defined as changes in your normal walking pattern, which can arise from disease or an abnormality of the body. Diagnostic testing includes:

  • Observation

  • Gait Speed

  • Balance

  • Strength

  • Range-of-Motion

  • Reflex

  • Sensation Screenings

Individualized treatment programs may consist of:

  • (Pre-)Gait Training

  • Balance and Coordination Training

  • Neuromuscular Reeducation


If you are experiencing difficulties walking, speak to a physical therapist.