A team of physical therapists at Blythedale Children’s Hospital has embarked on an important research study to assess walking velocity, as it relates to crossing a city street. The study utilizes the Hospital’s BalanceMaster, an interactive technology which offers visual feedback to patients as they stand on different surfaces, challenging and strengthening components of their balance skills.
The purpose of the study is to determine if selected sequence training using the BalanceMaster, added to established physical therapy treatment programs, will increase gait velocity of ambulatory children receiving in- or outpatient rehabilitation in relation to their ability to cross an intersection within the confines of a community traffic signal (a gait speed of 120 cm per second is the typical constraint imposed by most city traffic lights). By devising a setting where children are challenged to safely navigate a virtual street, therapists are able to collect data related to optimal speed and velocity.1
The BalanceMaster enables researchers to simulate the experience of crossing a city street by creating visual conflict, the sensation created by rough terrain or potholes, vestibular challenges, and a real world life experience.
Previous studies have shown that minimum velocity for crossing the street is seldom addressed or documented when assessing gait speed in patients, and that distances required for community independence were greater than those assessed in rehabilitation settings. Additionally, clients who are ambulatory within their rehabilitation environment often have a wheelchair or stroller for community maneuverability. One of the major criticisms of clinic/lab-based measures of gait speed is that relative performance may not be representative of independence within the community. Only one study evaluated gait speed in the clinical environment compared with the natural environment. This study showed poor agreement between clinically-tested ambulation speeds versus tests in natural surroundings. Finally, although pediatric standardized tests of motor skills evaluate walking performance as part of a multi-dimensional assessment, they don’t place these skills in the context of the environment in which the child must function. In addition to standard rehabilitation, sequence training using fundamental components of gait, such as weight shifting and dynamic mobility, may allow for a faster and greater improvement in gait velocity.1
Recognizing the importance of gait speed, as it relates to crossing streets, getting to class on time, and other important tasks of daily living, therapists developed a set of criteria by which participants would be selected for the study itself. To qualify for participation, children must be inpatients of Blythedale Children’s Hospital between the ages of five and 21, with an ability to ambulate independently with or without an assistive device and/or lower extremity orthoses; complete the functional assessment "Walk Across”; and possess the ability to follow and understand experimental procedures. In addition, they must not have a progressive disorder or visual field loss. To date, 44 children have participated in the study. Of the wide range of diagnoses represented, the most common are cerebral palsy, traumatic brain injury, acquired brain injury, remission from cancer, and Guillain-Barre syndrome. Because the patient population is so diverse, the team determined that a large number
of subjects were required in order to achieve meaningful data.
The children were randomly assigned to one of two groups: a weekly BalanceMaster sequence training group (in addition to their regularly scheduled therapy sessions) or a group that continued their regularly scheduled therapy sessions over a six-week period. Both groups were tested at baseline and after six weeks for gait velocity and balance. Gait velocity was measured by "Walk Across” Functional Assessment using the BalanceMaster long force plate.
Early results indicate that specialized balance training (that highlights weight shifting and dynamic mobility) increased study participant’s gait velocity when compared to that of subjects in the standard group. While both groups demonstrated change in velocity the mean speed for the trained subjects was 108 cm/sec., approaching the goal of 120 cm/sec. Assessment of gait in a contextual environment may be conducted in rehabilitation settings in order to promote carryover of therapeutic training within the community. This study suggests that work on gait components such as weight shifting and mobility using a tool such as the BalanceMaster for enhanced feedback may improve efficiency of training.1
"Analysis of walking speed is especially important to patients who live in a city and need to cross busy streets with uneven surfaces,” said Blythedale Chief Medical Officer Dr. Joelle Mast. "While gait has been well studied in adult patients, less is known about the gait function in the pediatric population who have gait impairment. This study reflects the emphasis on assessing children’s impairments in real life activities.”
The team presented their findings to date at the annual meeting of the American Physical Therapy Association in Florida, in June. The team plans to evaluate seven more subjects for a complete study.
Oversight was given for use of participants by Blythedale’s IRB. The research team includes Linda Fieback P.T., M.A., C-NDT; Nia Toomer-Mensah P.T., D.P.T; Mark Felsenfeld P.T., M.S.; and Teresa Smith P.T., M.S., NCS, C-NDT
1 Fieback, Linda - An Intervention Providing Sequence Training to Improve a Child’s Ability to Cross a Community Traffic Signal in a Safe and Timely Manner Using the Balance MasterTM: A Randomized Control Trial (2256-R) PTJ, May ‘12, Vol 92, Issue 5