The general aim of this work was to evaluate the outcome of specialised stroke rehabilitation and to examine the relation between both subjectively perceived and objectively assessed balance and impairments and some activity limitations. A further, integrated aim was to establish some psychometric properties and the usability of a newly developed Falls-Efficacy Scale, Swedish version (FES(S)) in stroke rehabilitation. Seventy-three patients younger than 70 years of age with a first stroke and reduced walking ability were randomised into an intervention group (walking on a treadmill with body weight support) and a control group (walking on the ground). Time points of assessment were: on admission for rehabilitation, at discharge and 10 months after stroke. Walking training on a treadmill with body weight support and walking training on the ground were found to be equally effective in the early rehabilitation. The patients in both groups improved their walking velocity, motor function, balance, self-efficacy and ADL performance. In a geriatric sample of 37 stroke patients examined at similar time points, significant improvements in self-efficacy, motor function, balance, ambulation and ADL occurred from admission to discharge independently of age. In comparison with observer-based balance measures, FES(S) at discharge was the most powerful predictor of ADL performance 10 months after onset of stroke. In 30 patients with stable stroke, the overall test-retest reliability of FES(S) was found to be adequate. The internal consistency confirmed that FES(S) has an adequate homogeneity. In a subsample of 62 patients from the original sample and in the geriatric sample, FES(S) correlated significantly with Berg’s balance scale, the Fugl-Meyer balance scale, with motor function and with gait performance. In the relatively younger group ADL (measured by the Functional Independence Measurement) correlated significantly with FES(S) on admission and at 10 months follow-up, while at discharge none of the FES(S) measures correlated significantly with ADL. In this subsample effect size statistics for detecting changes in FES(S) demonstrated very acceptable responsiveness of this scale during the early treatment period and during the total observation period In the light of these findings assessment and treatment of self-efficacy seems relevant in stroke rehabilitation.

No description available.

Syftet med denna uppsats var att undersöka vilka faktorer som påverkar hur förvärvsarbetande människor i Gävle använder sig av bil och aktiv transport när de transporterar sig till destinationer inom staden. Tio personer, fem butiksbiträden och fem lärare, intervjuades angående deras transportvanor och resonemang kring valet av transportsätt.Resultatet visade att aktiv transport var det vanligaste transportsättet till arbete, träning och butiker i centrum medan bilen var det vanligaste transportsättet till mataffären och destinationer på längre avstånd från hemmet. Avståndet till destinationen, tiden det tar att transportera sig, transport av eventuella varor, bekvämlighet, intresse av motion och rekreation, årstid, väder samt synen på ekonomi och miljö var faktorer som påverkade om deltagarna valde att transportera sig med bil eller aktiv transport. Definitionen på de olika faktorerna varierade mellan deltagarna, vilket kan tyda på att det är den personliga uppfattningen om de olika faktorerna som avgör vilket transportsätt som väljs. Det framkom ingen märkbar skillnad i resvanor mellan deltagare med olika utbildning och arbete.

Fall orsakar de allra flesta höftfrakturerna och en tredjedel av alla över 65 år i Sverige faller varje år. En persons self-efficacy kan påverka hur aktiv personen vågar vara efter en höftfraktur vilket torde påverka den postoperativa rehabiliteringen. Syfte: Syftet var att vid hemgång från ortopedavdelning efter operation för höftfraktur undersöka om fallrelaterade self-efficacy skiljer sig i olika äldre åldersgrupper samt samband mellan fallrelaterad self-efficacy, gångförmågan och antalet vårddagar. Metod: Medelåldern i studien var 78 år. 14 personer ingick i studien. 6 av personerna tillhörde gruppen äldre/äldre (≥80 år) och resterande tillhörde gruppen yngre/äldre (65-79 år). Personerna som ingick hade ingen till mild kognitiv nedsättning. Frågeformuläret Falls-efficacy scale svenska versionen (FES(S)) även gångtestet Timed Up and Go användes. Resultat: Studien kunde inte påvisa några statistiskt signifikanta skillnader i fallrelaterad self-efficacy mellan yngre/äldre och äldre/äldre på FES(S) och dess delskalor. De äldre/äldre skattade dock sin fallrelaterade self-efficacy högre än yngre/äldre. Sambandet mellan FES(S) delskala för personliga aktiviteter i dagliga livet (PADL) och TUG i gruppen äldre/äldre var statistiskt signifikant. Sambanden mellan antalet vårddagar och resultaten på FES(S) var lågt till måttligt. Konklusion: Att äldre/äldre skattar högre på FES(S) och har ett starkt samband med resultaten på TUG är något som avdelningar skulle kunna ta hänsyn till i sin rehabilitering genom att träna vardagsaktiviteter för att tillägna sig ökad förståelse av vad de möts av vid hemgång.

Tai Chi Chuan is a safe alternative for those who wish to improve balance and physical wellbeing. It is a popular form of exercise that is supported by a growing body of research aimed towards improving the health of a sedentary elderly population. The purpose of this study was to examine the biomechanical features of the lower extremity during performance of two Tai Chi movements, the “Repulse Monkey (RM)” and “Wave-hands in clouds (WHIC).” The study’s parameters included quantitative measures of the temporospatial, kinematic, and kinetic characteristics of the lower extremities. A group of experienced male Tai Chi practitioners (n = 15) between the ages of 65 to 75, performed “Repulse Monkey (RM)”, “Wave-hand in Cloud (WHIC)”, and forward walking. Three-dimensional (3-D) kinematic and kinetic data was collected using VICON motion analysis system with 10 infrared cameras and 4 force plates. The following variables were examined: stride width, step length, step width, single- and double-support times, centre of mass (COM) displacement, peak joint angles, range of motion, peak joint moments, time to peak moment, and ground reaction force (GRF). The differences in the measurements of the two Tai Chi movements were compared with walking using two-way ANOVA. The study’s results showed that the two Tai Chi movements elicit gentle and fluid changes to position of the upper body mass and the joints in the lower extremity. In terms of joint kinematics, the knee remained flexed throughout RM and WHIC. Unlike walking, RM had larger abduction and adduction angles at the knee joints and large plantar- and dorsiflexion ROM at the ankle. Reduced posterior, mediolateral, and vertical GRF were seen; the loading joints at the ankle and hip were gentle and smaller than walking. Varus/valgus moments were notably larger at the knee joint during RM and eversion moment was larger at the ankle joint during WHIC movement. A large, but slow loading rate at the knee joint has implication towards the viscoelastic properties of the knee. A better understanding of RM and WHIC would facilitate the improvement of balance, physical capacity, and joint flexibility for the elders.

This paper is about my experience walking through Los Angeles County. My principal motivations were to explore what it means to be a pedestrian in an urban landscape that generally does not recognize walkers and to give value to often overlooked spaces. The paper includes a brief history of the Los Angeles region, methodology, an analysis of some other art projects that have been done about walking, and a vignette of the experience.

The physiological energy requirements of prosthetic gait in lower-limb amputees have been observed to be significantly greater than those for able-bodied subjects. However, existing models of energy flow in walking have not been very successful in explaining the reasons for this additional energy cost. Existing mechanical models fail to capture all of the components of energy cost involved in human walking. In this thesis, a new model is developed that estimates the physiological cost of walking for an able-bodied individual; the same cost of walking is then computed using a variation of the model that represents a bi-lateral below-knee amputee. The results indicate a higher physiological cost for the amputee model, suggesting that the model more accurately represents the relative metabolic costs of able-bodied and amputee walking gait. The model is based on a two-dimensional multi-body mechanical model that computes the joint torques required for a specified pattern of joint kinematics. In contrast to other models, the mechanical model includes a balance controller component that dynamically maintains the stability of the model during the walking simulation. This allows for analysis of many consecutive steps, and includes in the metabolic cost estimation the energy required to maintain balance. A muscle stress based calculation is used to determine the optimal muscle force distribution required to achieve the joint torques computed by the mechanical model. This calculation is also used as a measure of the metabolic energy cost of the walking simulation. Finally, an optimization algorithm is applied to the joint kinematic patterns to find the optimal walking motion for the model. This approach allows the simulation to find the most energy efficient gait for the model, mimicking the natural human tendency to walk with the most efficient stride length and speed.

Bakgrund: Att råka ut för en osteoporosrelaterad höftfraktur medför ofta att personernas funktionsnivå försämras mer än vad som kan förklaras av åldrandet i sig. Syfte: Att hos personer som blir inlagda på sjukhus på grund av höftfraktur, dels beskriva könsskillnader och dels identifiera riskfaktorer för nedsatt gångförmåga och smärta i den opererade höften fyra månader postoperativt. Metod: En registerstudie där 1000 personer, 50 år och äldre, med icke patologisk höftfraktur ingick. Registermaterialet analyserades dels deskriptivt och dels med multivariata regressionsmodeller för att undersöka riskfaktorer för nedsatt gångförmåga och smärta. Resultat: Kvinnorna var äldre, friskare enligt ASA, använde mer gånghjälpmedel och bodde oftare ensamma innan frakturen jämfört med männen. Riskfaktorer för nedsatt gångförmåga var högre ålder (OR = 1,07; 95% CI, 1,05-1,10), att vara svårare sjuk enligt ASA (OR = 2,04; 95% CI, 1,50-2,77) och att inte använda gånghjälpmedel (OR = 0,36; 95% CI, 0,25-0,53). Riskfaktorer för smärta i den opererade höften var lägre ålder (OR = 0,95; 95% CI, 0,92-0,97) och att inte använda gånghjälpmedel före fraktur (OR = 0,68; 95% CI, 0,47-0,99). Slutsats: Det är viktigt att utveckla rehabiliteringsprocessen för att minska risken för nedsatt gångförmåga speciellt för äldre personer och att optimera smärtbehandlingen framför allt till de yngre. / Background: To incur a hip fracture often means that people's level of function deteriorates more than can be explained by the aging process itself. Objective: To describe gender differences and also identify risk factors for impaired walking ability and pain in the operated hip four months postoperatively. Method: A register study in which 1,000 people, aged 50 and older, with non-pathological hip fracture were included. Index was analyzed partly descriptive and partly by multivariate regression models to examine risk factors for impaired walking ability and pain. Results: The women were older, healthier according to ASA, using more walking aids and more often lived alone before the fracture compared with men. Risk factors for impaired walking ability were older age (OR = 1.07, 95% CI, 1.05-1.10), to be affected with severe illness according to ASA (OR = 2.04, 95% CI, 1.50-2.77) and not using walking aids (OR = 0.36, 95% CI, 0.25-0.53). Risk factors for pain in the operated hip were younger age (OR = 0.95, 95% CI, 0.92-0.97) and not using walking aids before fracture (OR = 0.68, 95% CI, 0.47-0.99). Conclusion: It is important to develop the rehabilitation process to reduce the risk of impaired walking ability especially for older people and to optimize pain management particular to the young.

The physiological energy requirements of prosthetic gait in lower-limb amputees have been observed to be significantly greater than those for able-bodied subjects. However, existing models of energy flow in walking have not been very successful in explaining the reasons for this additional energy cost. Existing mechanical models fail to capture all of the components of energy cost involved in human walking. In this thesis, a new model is developed that estimates the physiological cost of walking for an able-bodied individual; the same cost of walking is then computed using a variation of the model that represents a bi-lateral below-knee amputee. The results indicate a higher physiological cost for the amputee model, suggesting that the model more accurately represents the relative metabolic costs of able-bodied and amputee walking gait. The model is based on a two-dimensional multi-body mechanical model that computes the joint torques required for a specified pattern of joint kinematics. In contrast to other models, the mechanical model includes a balance controller component that dynamically maintains the stability of the model during the walking simulation. This allows for analysis of many consecutive steps, and includes in the metabolic cost estimation the energy required to maintain balance. A muscle stress based calculation is used to determine the optimal muscle force distribution required to achieve the joint torques computed by the mechanical model. This calculation is also used as a measure of the metabolic energy cost of the walking simulation. Finally, an optimization algorithm is applied to the joint kinematic patterns to find the optimal walking motion for the model. This approach allows the simulation to find the most energy efficient gait for the model, mimicking the natural human tendency to walk with the most efficient stride length and speed.

A predictive, forward-dynamic model and computer simulation of human gait has important medical and research applications. Most human simulation work has focused on inverse dynamics studies to quantify bone on bone forces and muscle loads. Inverse dynamics is not predictive - it works backwards from experimentally measured motions in an effort to find the forces that caused the motion. In contrast, forward dynamics determines how a mechanism will move without the need for experimentation. Most of the forward dynamic gait simulations reported consider only one step, foot contact is not modeled, and balance controllers are not used. This thesis addresses a few of the shortcomings of current human gait simulations by contributing an experimentally validated foot contact model, a model-based stance controller, and an experimentally validated model of the relationship between foot placement location and balance. The goal of a predictive human gait simulation is to determine how a human would walk under a condition of interest, such as walking across a slippery floor, using a new lower limb prosthesis, or with reduced leg strength. To achieve this goal, often many different gaits are simulated and the one that is the most human-like is chosen as the prediction for how a person would move. Thus it is necessary to quantify how `human-like' a candidate gait is. Human walking is very efficient, and so, the metabolic efficiency of the candidate gait is most often used to measure the performance of a candidate gait. Muscles consume metabolic energy as a function of the tension they develop and the rate at which they are contracting. Muscle tension is developed, and contractions are made in an effort generate torques about joints in order to make them move. To predict human gait, it is necessary for the simulation to be able to walk in such a way that the simulated leg joints use similar joint torques and kinematics as a human leg does, all while balancing the body. The joint torques that the legs must develop to propel the body forward, and balance it, are heavily influenced by the ground reaction forces developed between the simulated foot and the ground. A predictive gait simulation must be able to control the model so that it can walk, and remain balanced while generating ground reaction force profiles that are similar to experimentally observed human ground reaction force profiles. Ground reaction forces are shaped by the way the foot interacts with the ground, making it very important to model the human foot accurately. Most continuous foot contact models present in the literature have been experimentally validated using pendulum impact methods that have since been shown to produce inaccurate results. The planar foot contact model developed as part of this research was validated in-vivo using conventional force plates and optical tracking markers. The experimental data was also highly useful for developing a computationally efficient foot model by identifying the dominant contact properties of a real foot (during walking), without the complexity of modelling the 26 bones, 33 joints, over 90 ligaments, and the network of muscles that are in a real foot. Both ground reaction forces and the balance of the model are heavily influenced by the way the stance limb is controlled. Anthropomorphic multibody models typically have a fragile sense of balance, and ground reaction force profiles that do not look similar to experimentally measured human ground reaction force profiles. In contrast, the simple point-mass spring-loaded-inverted-pendulum (SLIP) can be made to walk or run in a balanced manner with center-of-mass (COM) kinematics and ground reaction force profiles that could be mistaken for the equivalent human data. A stance limb controller is proposed that uses a planar SLIP to compute a reference trajectory for a planar anthropomorphic multibody gait model. The torso of the anthropomorphic model is made to track the computed trajectory of the SLIP using a control system. The aim of this partitioned approach to gait simulation is to endow the anthropomorphic model with the human-like gait of the simpler SLIP model. Although the SLIP model-based stance-controller allows an anthropomorphic gait model to walk in more human-like manner, it also inherits the short comings of the SLIP model. The SLIP can walk or run like a human, but only at a fixed velocity. It cannot initiate or terminate gait. Fall preventing movements, such as gait termination and compensatory stepping, are of particular relevance to kinesiologists and health care professionals. Kinesiologists have known for nearly a decade that humans restore their balance primarily by systematically altering their foot placement location. This thesis presents a human experimental validation of a planar foot placement algorithm that was originally designed to restore the balance of bipedal robots. A three-dimensional (3D) theoretical extension to the planar foot placement algorithm is also presented along with preliminary human experimental results. These models of foot placement can be used in the future to improve the capabilities of gait simulations by giving simple models human-like compensatory stepping abilities. The theoretical extension also provides some insight into how instability and balance performance can be quantified. The instability and balance performance measures have important applications for diagnosing and rehabilitating balance problems. Despite all of the progress that has been made, there is still much work to be done. Work needs to be continued to find methods that allow the anthropomorphic model to emulate the SLIP model more faithfully. Experimental work needs to be completed to realize the potential diagnostic and rehabilitation applications of the foot placement models. With continued effort, a predictive, balanced, multi-step gait simulation can be developed that will give researchers the time-saving capability of computerized hypothesis testing, and medical professionals improved diagnostic and rehabilitation methods.