Polio survivors have poorer walking adaptability than healthy individuals

Tuijtelaars, Jana; Roerdink, Melvyn; Raijmakers, Bart; Nollet, Frans; Brehm, Merel-Anne

doi:10.1016/j.gaitpost.2021.04.031

Cited by 13 publications

(16 citation statements)

References 24 publications

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“…Walking-related falls in polio survivors mostly occur after tripping, slipping or misplaced steps ( 3 , 16 ), possibly because polio survivors are less able to avoid such perturbations, due to reduced walking adaptability. We recently confirmed reduced walking adaptability in polio survivors ( 17 ). This raises the question as to whether walking-induced fatigue increases polio survivors’ walking-related fall risk by further degrading their already limited walking-adaptability performance.…”

supporting

confidence: 58%

“…4), which might be explained by increasing balance impairments when the most-affected leg serves as the stance leg (34). Altogether, these findings suggest that walking-induced fatigue increases balance impairments in polio survivors, which further degrades their already limited walking adaptability (17) and contributes to their high fall risk.…”

Section: Discussionmentioning

confidence: 90%

“…For this cross-sectional study, participants of an observational 2-year follow-up study on walking adaptability were approached to participate (see ( 17 ) for a description of the tests involved in that study). The study protocol was approved by the medical ethics committee of the Academic Medical Center (AMC), Amsterdam, The Netherlands.…”

Section: Methodsmentioning

confidence: 99%

“…For polio survivors, the number of falls in the previous year was obtained via a questionnaire. Leg-muscle strength scores were used from the baseline measurements of the 2-year longitudinal study ( 17 ), as assessed with the Medical Research Council (MRC) scale score (range 0–5, lower scores indicating lower strength) ( 21 ) for 8 lower-extremity muscle groups. MRC sum-scores were calculated per leg from the individual MRC scores and used to define most and least-affected legs (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…For normal walking, spatiotemporal gait parameters were calculated as described previously ( 26 ), using foot-contact indices ( 24 ). For target stepping, only steps for which the CoP-position at midstance fell within the target boundaries were included to assure goal-directed stepping ( 17 ). Over these steps, the variable stepping error (VE, in mm) was calculated as the standard deviation over the distances from the centre location of the stepping target to the CoP-location at midstance.…”

Section: Methodsmentioning

confidence: 99%

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Six Minutes Walking in Polio Survivors: Effects on Fatigue and Walking Adaptability

Tuijtelaars

Keller

Nollet

et al. 2022

JRM

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Objective: To investigate whether 6-min walking is fatiguing for polio survivors, and how fatigue influences their normal and adaptive walking.Design: Cross-sectional study.Patients: Polio survivors (n = 23) with ≥ 1 fall and/or fear of falling reported in the previous year and healthy individuals (n = 11).Methods: Participants performed 1 normal-walk test and 2 walking-adaptability tests (target stepping and narrow-beam walking) on an instrumented treadmill at fixed self-selected speed, each test lasting 6 min. Leg-muscle fatigue (leg-muscle activation, measured with surface electromyography), cardiorespiratory fatigue (heart rate, rate of perceived exertion), gait and walking-adaptability performance were assessed. The study compared: (i) the first and last minute per test, (ii) normal and adaptive walking, and (iii) groups.Results: Leg-muscle activation did not change during normal walking (p > 0.546), but declined over time during adaptive walking, especially in polio survivors (p < 0.030). Cardiorespiratory fatigue increased during all tests (p < 0.001), especially in polio survivors (p < 0.01), and was higher during adaptive than normal walking (p < 0.007). Target-stepping performance declined in both groups (p = 0.007), while narrow-beam walking improved in healthy individuals (p < 0.001) and declined in polio survivors (p < 0.001).Conclusion: Cardiorespiratory fatigue might further degrade walking adaptability, especially among polio survivors during narrow-beam walking. This might increase the risk of falls among polio survivors. LAY ABSTRACTThis study investigated whether prolonged walking is fatiguing for polio survivors and how this affects their ability to adapt walking to environmental circumstances (i.e. walking adaptability), which is an important skill for safe daily-life walking. A total of 23 polio survivors and 11 healthy individuals performed 1 normal-walk test and 2 walking-adaptability tests. To assess fatigue, leg-muscle activation, heart rate and rate of perceived exertion were measured. In addition, gait and walking-adaptability outcomes were assessed. The first and last minute per test, normal and adaptive walking, and groups were compared. Based on higher leg-muscle activation, heart rate and rate of perceived exertion, the study concluded that 6-min walking was more fatiguing for polio survivors than for healthy individuals and that adaptive walking was more fatiguing than normal walking, especially in polio survivors. Walking- induced fatigue further limits walking adaptability among polio survivors, which could increase their fall risk.

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supporting

confidence: 58%

Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%