To investigate the effect of treadmill walking exercise as a treatment method to improve gait efficiency in adults with cerebral palsy (CP) and to determine gait efficiency during overground walking after the treadmill walking exercise.
Fourteen adults with CP were recruited in the experimental group of treadmill walking exercise. A control group of 7 adults with CP who attended conventional physical therapy were also recruited. The treadmill walking exercise protocol consisted of 3-5 training sessions per week for 1-2 months (total 20 sessions). Gait distance, velocity, VO2, VCO2, O2 rate (mL/kg·min), and O2 cost (mL/kg·m) were assessed at the beginning and at the end of the treadmill walking exercise. The parameters were measured by KB1-C oximeter.
After the treadmill walking exercise, gait distance during overground walking up to 6 minutes significantly increased from 151.29±91.79 to 193.93±79.01 m, and gait velocity increased from 28.09±14.29 to 33.49±12.69 m/min (p<0.05). Energy efficiency evaluated by O2 cost during overground walking significantly improved from 0.56±0.36 to 0.41±0.18 mL/kg·m (p<0.05), whereas O2 rate did not improve significantly after the treadmill walking exercise. On the other hand, gait velocity and O2 cost during overground walking were not significantly changed in the control group.
Treadmill walking exercise improved the gait efficiency by decreased energy expenditure during overground walking in adults with CP. Therefore, treadmill walking exercise can be an important method for gait training in adults with CP who have higher energy expenditure.
Citations
Objective: To investigate the clinical usefulness of scintigraphy for the evaluation of dysphagia in patients with brain lesion and to clarify the most useful quantitative parameter for detection of aspiration using scintigraphy.
Method: For 42 patients with dysphagia, swallowing evaluations were done by videofluoroscopy and scintigraphy. According to videofluoroscopic findings these patients were grouped into three; aspiration, laryngeal penetration and no penetration group. Quantitative parameters from scintigraphy were measured and compared among three patients groups and normal control; these parameters were oral discharge time (ODT), pharyngeal transit time (PTT), oral residue (OR), pharyngeal residue (PR), pharyngeal swallowing efficiency (PSE) and oro-pharyngeal swallowing efficiency (OPSE). Sensitivity and specificity of these parameters detecting aspiration were also evaluated according to the videofluoroscopic findings.
Results: In aspiration group ODT, PTT, PSE and OPSE were 1.18⁑1.14 sec, 1.80⁑1.49 sec, 86.05⁑61.42%/sec and 38.21⁑28.65%/sec respectively, all of which were significantly different from the other groups, but OR and PR were not different statistically. According to the ROC (Relative Operating Characteristic) table, sensitivity and specificity of OPSE were 72.7 and 80.7% respectively, which were the highest among the parameters.
Conclusion: Scintigraphy was useful to quantitative dysphagia in patients with brain lesion. Sensitivity and specificity of swallowing efficiency was higher than time and residue parameters. OPSE was considered to be the most useful quantitative parameter for detecting aspiration.
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