Enhancing sensory acuity and balance function using near-sensory biofeedback-based perturbation intervention for individuals with traumatic brain injury

2020 ◽  
pp. 1-9
Author(s):  
Akhila Veerubhotla ◽  
Rakesh Pilkar ◽  
Naphtaly Ehrenberg ◽  
Karen J. Nolan
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intervention Group ◽  
Berg Balance Scale ◽  
Walk Test ◽  
Post Intervention ◽  
Timed Up And Go ◽  
Perception Threshold ◽  
Balance Intervention ◽  
Sensory Acuity

BACGROUND: Interventions addressing balance dysfunction after traumatic brain injury (TBI) only target compensatory aspects and do not investigate perceptual mechanisms such as sensory acuity. OBJECTIVE: To evaluate the efficacy of a novel intervention that integrates sensory acuity with a perturbation-based approach for improving the perception and functional balance after TBI. METHODS: A two-group design was implemented to evaluate the effect of a novel, perturbation-based balance intervention. The intervention group (n = 5) performed the intervention with the sinusoidal (0.33, 0.5, and 1 Hz) perturbations to the base of support with amplitudes derived using our novel outcome of sensory acuity - perturbation perception threshold (PPT). The efficacy is evaluated using changes in PPT and functional outcomes (Berg Balance Scale (BBS), Timed-up and Go (TUG), 5-meter walk test (5MWT), and 10-meter walk test (10MWT)). RESULTS: There was a significant post-intervention change in PPT for 0.33 Hz (p = 0.021). Additionally, clinically and statistically significant improvements in TUG (p = 0.03), 5MWT (p = 0.05), and 10MWT (p = 0.04) were observed. CONCLUSIONS: This study provides preliminary efficacy of a novel, near-sensory balance intervention for individuals with TBI. The use of PPT is suggested for a comprehensive understanding and treatment of balance dysfunction. The promising results support the investigation in a larger cohort.

scholarly journals Evaluation of the Effect of Atorvastatin Administration on the Outcomes of Patients with Traumatic Brain Injury: A Double-Blinded Randomized Clinical Trial

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Farhad Soltani ◽  
Farahzad Janatmakan ◽  
Sara Jorairahmadi ◽  
Fatemeh Javaherforooshzadeh ◽  
Pooyan Alizadeh ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Randomized Clinical Trial ◽  
Rating Scale ◽  
Intervention Group ◽  
Control Group ◽  
Post Intervention ◽  
Disability Rating Scale ◽  
Double Blinded

Background: Traumatic brain injury (TBI) is one of the common causes of long-term disabilities and mortality. This study aimed to evaluate the effect of atorvastatin administration on the Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and Disability Rating Scale (DRS) in patients with TBI. Methods: This double-blinded randomized clinical trial included 60 patients with TBI in Golestan Hospital of Ahvaz, Iran. After obtaining an informed consent from all patients, the patients were randomly assigned into two groups. For the intervention group, atorvastatin with a daily dose of 20 mg was used. The control group was administered the same amount of placebo for 10 days. Changes in the level of consciousness were measured using the GCS, and functional recovery rate in patients was measured by GOS and DRS in the third follow-up month. Results: According to the obtained results, compared with the control group, the atorvastatin administration significantly increased the level of GCS and DRS within 2 - 3 months post-intervention and improved GOS since the tenth day after the study (P < 0.05). Conclusions: The results revealed the positive effect of atorvastatin on the improvement of outcomes measurements such as GCS, DRS, and GOS in patients after moderate and severe TBI.

An intervention to improve coping strategies in adult male prisoners with a history of traumatic brain injury: A pilot randomised clinical trial

2021 ◽  
pp. 026921552199853
Author(s):  
Tracey Mitchell ◽  
Elizabeth du Preez ◽  
Alice Theadom
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Negative Affect ◽  
Coping Strategies ◽  
Psychological Intervention ◽  
Intervention Group ◽  
Wait List ◽  
Post Intervention ◽  
History Of

Objective: To determine whether a psychological intervention improves coping, post-concussion symptoms and decreases in-prison infractions in adult males with a history of traumatic brain injury. Design: A single centre, randomised, wait-list, pilot study. Setting: A high security prison in New Zealand. Subjects: Fifty-five adult male participants who had experienced at least one traumatic brain injury in their lifetime (mean age 37.29 +/−9.81 years). Intervention: A manualised ten session, in-person, group based combined Cognitive Behavioural Therapy /Mindfulness Based Stress Reduction intervention versus wait list control. Main measures: The Negative Affect Repair Questionnaire and Rivermead Post-concussion Symptom Questionnaire were completed at baseline, post-intervention (five weeks) and at 12 week follow up. In-prison misconduct charges and negative file notes were reviewed for the previous five weeks at each assessment time point. Results: There was an improvement in the use of calming and distraction strategies in the intervention group from baseline ( x̄ = 17.38, SD = 3.57) to post-intervention ( x̄ = 18.67, SD = 3.84) and 12-week follow up ( x̄ = 18.13, SD = 2.63). Participants in the intervention group had significantly higher negative affect repair on the calming and distractive strategies subscale following completion of the intervention, compared to wait-list controls ( F = 4.69, P = 0.04) with a moderate effect size (ηp2 = 0.11). Improvements in use of calming and distractive strategies was not sustained at the twelve-week follow-up ( F = 0.87, P = 0.36). There was no-significant improvement on other negative affect subscales or for post-concussion symptoms or decrease in-prison infractions. Conclusion: A manualised psychological intervention may have the potential to facilitate the development of positive coping strategies in prisoners with a history of traumatic brain injury.

scholarly journals Neurosurgical intervention in patients with mild traumatic brain injury and its effect on neurological outcomes

2016 ◽  
Vol 124 (2) ◽  
pp. 538-545 ◽  
Author(s):  
Kevin James Tierney ◽  
Natasha V. Nayak ◽  
Charles J. Prestigiacomo ◽  
Ziad C. Sifri
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Nonoperative Management ◽  
Intervention Group ◽  
Clinical Predictors ◽  
Neurological Outcomes ◽  
Cranial Ct ◽  
Delayed Intervention ◽  
Neurosurgical Intervention

OBJECT The object of this study was to determine the mortality and neurological outcome of patients with mild traumatic brain injury (mTBI) who require neurosurgical intervention (NSI), identify clinical predictors of a poor outcome, and investigate the effect of failed nonoperative management and delayed NSI on outcome. METHODS A cross-sectional study of 10 years was performed, capturing all adults with mTBI and NSI. Primary outcome variables were mortality and Glasgow Outcome Scale (GOS) score. Patients were divided into an immediate intervention group, which received an NSI after the initial cranial CT scan, and a delayed intervention group, which had failed nonoperative management and received an NSI after 2 or more cranial CT scans. RESULTS The mortality rate in mTBI patients requiring NSI was 13%, and the mean GOS score was 3.6 ± 1.2. An age > 60 years was independently predictive of a worse outcome, and epidural hematoma was independently predictive of a good outcome. Logistic regression analysis using independent variables was calculated to create a model for predicting poor neurological outcomes in patients with mTBI undergoing NSI and had 74.1% accuracy. Patients in the delayed intervention group had worse mortality (25% vs 9%) and worse mean GOS scores (2.9 ± 1.3 vs 3.7 ± 1.2) than those in the immediate intervention group. CONCLUSIONS Data in this study demonstrate that patients with mTBI requiring NSI have higher mortality rates and worse neurological outcomes and should therefore be classified separately from mTBI patients not requiring NSI. Additionally, mTBI patients requiring NSI after the failure of nonoperative management have worse outcomes than those receiving immediate intervention and should be considered separately.

Effects of proprioception training program on balance among patients with diabetic neuropathy: a quasi experimental trial

2021 ◽  
pp. 1-12
Author(s):  
Humaira Iram ◽  
Muhammad Kashif ◽  
Hafiz Muhammad Junaid Hassan ◽  
Salma Bunyad ◽  
Samra Asghar
Keyword(s):  
Diabetic Neuropathy ◽  
Dynamic Balance ◽  
Berg Balance Scale ◽  
Exercise Group ◽  
Walk Test ◽  
Timed Up And Go ◽  
Functional Reach ◽  
Functional Reach Test ◽  
Quasi Experimental ◽  
Eyes Open

Abstract Objective: To determine the effects of proprioception training in improving balance in patients with diabetic neuropathy. Methods: A quasi-experimental design study was conducted at the Safi Hospital Faisalabad for eight weeks from August to December 2019. Out of, 38, 19 patients were placed in exercise group (10 males, 9 females; mean age 64 ± 7.7 years; range 60 to 83 years) and 19 patients were placed in controls group (12 males, 7 females; mean age 63 ± 8.2 years) were included in this study through consecutive sampling technique. Proprioception Training was given to exercise group twice a week for eight weeks and the diabetes awareness campaign was given once a week to the control group. Static and dynamic balance were assessed by using One Leg Standing (OLS) Test with eyes open and closed, Berg Balance Scale (BBS), Functional Reach Test (FRT), Timed Up and Go Test (TUGT) and 10-M Walk Test (10-MWT). The data was collected before and after treatment and was compared using independent sample t-test. Results: The finding of the study showed that OLS score with eyes open improved significantly with p<0.05 and does not show improvement with eyes closed p =.073. The dynamic balance from the Berg Balance Scale, Functional Reach Test, Timed Up and Go Test and 10-M Walk Test revealed significant improvement after the balance exercises with p<0.05 Conclusion: It is concluded that proprioception training exercises are effective in improving balance among patients with Diabetic neuropathy. Continuous...

scholarly journals Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review

2020 ◽  
Vol 14 ◽  
Author(s):  
Francesca Buhagiar ◽  
Melinda Fitzgerald ◽  
Jason Bell ◽  
Fiona Allanson ◽  
Carmela Pestell
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Post Intervention ◽  
Persistent Symptoms ◽  
Positive Effects ◽  
The Brain

Background: Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain.Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population.Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations.Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial.Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.

Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: a randomized controlled trial

2016 ◽  
Vol 31 (2) ◽  
pp. 217-224 ◽  
Author(s):  
Ibolya Mikó ◽  
Imre Szerb ◽  
Anna Szerb ◽  
Gyula Poor
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Balance Training ◽  
Training Programme ◽  
Exercise Programme ◽  
Berg Balance Scale ◽  
Control Group ◽  
Timed Up And Go ◽  
Randomized Controlled

Objective: To investigate the effect of a 12-month sensomotor balance exercise programme on postural control and the frequency of falling in women with established osteoporosis. Design: Randomized controlled trial where the intervention group was assigned the 12-month Balance Training Programme and the control group did not undertake any intervention beyond regular osteoporosis treatment. Subjects: A total of 100 osteoporotic women – at least with one osteoporotic fracture – aged 65 years old and above. Main measures: Balance was assessed in static and dynamic posture both with performance-based measures of balance, such as the Berg Balance Scale and the Timed Up and Go Test, and with a stabilometric computerized platform. Interventions: Patients in the intervention group completed the 12-month sensomotor Balance Training Programme in an outpatient setting, guided by physical therapists, three times a week, for 30 minutes. Results: The Berg Balance Scale and the Timed Up and Go Test showed a statistically significant improvement of balance in the intervention group ( p = 0.001 and p = 0.005, respectively). Balance tests using the stabilometer also showed a statistically significant improvement in static and dynamic postural balance for osteoporotic women after the completion of the Balance Training Programme. As a consequence, the one-year exercise programme significantly decreased the number of falls in the exercise group compared with the control group. Conclusion: The Balance Training Programme significantly improved the balance parameters and reduced the number of falls in postmenopausal women who have already had at least one fracture in the past.

scholarly journals Аналіз наявних інструментів оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона

2021 ◽  
pp. 84-91
Author(s):  
В. Брушко ◽  
Р. Баннікова ◽  
А. Ковельська
Keyword(s):  
Dual Task ◽  
Berg Balance Scale ◽  
Walk Test ◽  
Walk Distance ◽  
Timed Up And Go ◽  
Sf 36 ◽  
Minute Walk Distance ◽  
Minute Walk ◽  
Disease Questionnaire ◽  
10 Meter Walk Test

Резюме. Правильний і обґрунтований вибір інструментальних методів оцінювання функціо-нального стану пацієнта є обов’язковою умовою адекватної фізичної терапії. Особливе місце цей аспект займає в системі нейрореабілітації пацієнтів з хворобою Паркінсона в Україні, оскільки на сьогодні кількість осіб, що потребують систематичної фізичної терапії, сягає 23 900 тис. Наростаюча маніфестація моторних і немоторних симптомів при хворобі Паркін-сона, від яких часто вирішальною мірою залежить тяжкість стану пацієнта, негативно впливає на якість його життя. Наявні функціональні порушення, які є самостійними проявами хвороби Паркінсона, вимагають специфічного підходу до комплексного інструментального досліджен-ня цих порушень для визначення диференційно-діагностичних критеріїв та оцінювання впливу фізіотерапевтичного втручання. Мета. Проаналізувати наявні інструменти оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона. Методи. Теоретичний аналіз та узагальнення зарубіжних даних спеціальної науково-методичної літератури з питань застосування інстру-ментів оцінювання при хворобі Паркінсона та їх інформативності і надійності у фізичній терапії. Результати. Представлені дані свідчать, що ефективність запроваджених заходів фізичної терапії при хворобі Паркінсона залежить від правильно підібраних інструментів оцінювання, які дозволяють оцінити моторні і немоторні проблеми через призму життєдіяльності і якості життя пацієнта. Основним інструментом оцінювання для вирішення цього питання вважаєть-ся Уніфікована рейтингова шкала хвороби Паркінсона MDS-UPDRS, яка дозволяє об’єктивно оцінити моторні і немоторні аспекти життя пацієнта і його рухову активність. Оскільки наявні моторні й аксіальні рухові порушення негативно впливають на повсякденну функціональну активність пацієнта, для верифікації цих порушень пропонують використовувати тест для оці-нювання часу підйому і ходьби (Timed Up and Go (TUG)); тест з подвійним завданням (Dual-Task TUG (TUG-DT)) та шкалу рівноваги Берга (Berg Balance Scale (BBS)). Але виходячи з того, що ці тести недостатньо чутливі до невеликих змін у рухливості при хворобі Паркінсона, особливо на середніх і пізніх стадіях захворювання, їх доцільно поєднувати з одним із кількісних тестів для оцінювання ходьби: 10-метровим тестом ходьби (10 Meter Walk Test (10MW)) та 6-хвилинним тестом ходьби (Six Minute Walk Distance (6MWT)). Поняття «життєдіяльність» включає в себе не тільки переміщення, її оцінювання має бути доповнено аналізом ступеня впливу наявних по-рушень на повсякденну діяльність, тобто на якість життя пацієнта. Найбільш інформативними інструментами для проведення цього аналізу є універсальні і специфічні при хворобі Паркінсо-на опитувальники з метою оцінювання стану здоров’я SF-36, EuroQOL (EQ-5D) і PDQ-39 (The Parkinson’s Disease Questionnaire). Результати аналізу та узагальнення даних науково-мето-дичної літератури дають підставу встановити, що маніфестація порушень та їх варіабельність при хворобі Паркінсона стають серйозною проблемою у досягненні кінцевого результату за-проваджених заходів фізичної терапії на всіх стадіях захворювання. Використання в комплексі стандартної експертно-реабілітаційної діагностики спеціальних інструментів оцінювання дозволяє об’єктивізувати оцінювання клінічної інформації та стимулює розроблення особисто-орієнтованих реабілітаційних стратегій із застосуванням заходів фізичної терапії, спрямованих на покращення якості життя пацієнтів з хворобою Паркінсона. Ключові слова: хвороба Паркінсона, фізична терапія, якість життя, інструменти оцінювання, достовірність, надійність, валідність.

scholarly journals Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

2020 ◽  
Vol 9 (6) ◽  
pp. 2000
Author(s):  
Shannon Cooper ◽  
Cino Bendinelli ◽  
Andrew Bivard ◽  
Mark Parsons ◽  
Zsolt J. Balogh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Injury Severity ◽  
Intervention Group ◽  
Small Sample ◽  
Perfusion Computed Tomography ◽  
Group I ◽  
Second Tier

The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension

2009 ◽  
Vol 4 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Gad Bar-Joseph ◽  
Yoav Guilburd ◽  
Ada Tamir ◽  
Joseph N. Guilburd
Keyword(s):  
Blood Pressure ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Repeated Measures ◽  
Intervention Group ◽  
Decrease Blood Pressure ◽  
Group 2 ◽  
Group 1

Object Deepening sedation is often needed in patients with intracranial hypertension. All widely used sedative and anesthetic agents (opioids, benzodiazepines, propofol, and barbiturates) decrease blood pressure and may therefore decrease cerebral perfusion pressure (CPP). Ketamine is a potent, safe, rapid-onset anesthetic agent that does not decrease blood pressure. However, ketamine's use in patients with traumatic brain injury and intracranial hypertension is precluded because it is widely stated that it increases intracranial pressure (ICP). Based on anecdotal clinical experience, the authors hypothesized that ketamine does not increase—but may rather decrease—ICP. Methods The authors conducted a prospective, controlled, clinical trial of data obtained in a pediatric intensive care unit of a regional trauma center. All patients were sedated and mechanically ventilated prior to inclusion in the study. Children with sustained, elevated ICP (> 18 mm Hg) resistant to first-tier therapies received a single ketamine dose (1–1.5 mg/kg) either to prevent further ICP increase during a potentially distressing intervention (Group 1) or as an additional measure to lower ICP (Group 2). Hemodynamic, ICP, and CPP values were recorded before ketamine administration, and repeated-measures analysis of variance was used to compare these values with those recorded every minute for 10 minutes following ketamine administration. Results The results of 82 ketamine administrations in 30 patients were analyzed. Overall, following ketamine administration, ICP decreased by 30% (from 25.8 ± 8.4 to 18.0 ± 8.5 mm Hg) (p < 0.001) and CPP increased from 54.4 ± 11.7 to 58.3 ± 13.4 mm Hg (p < 0.005). In Group 1, ICP decreased significantly following ketamine administration and increased by > 2 mm Hg during the distressing intervention in only 1 of 17 events. In Group 2, when ketamine was administered to lower persistent intracranial hypertension, ICP decreased by 33% (from 26.0 ± 9.1 to 17.5 ± 9.1 mm Hg) (p < 0.0001) following ketamine administration. Conclusions In ventilation-treated patients with intracranial hypertension, ketamine effectively decreased ICP and prevented untoward ICP elevations during potentially distressing interventions, without lowering blood pressure and CPP. These results refute the notion that ketamine increases ICP. Ketamine is a safe and effective drug for patients with traumatic brain injury and intracranial hypertension, and it can possibly be used safely in trauma emergency situations.

scholarly journals Walking Ability Outcome Measures in Individuals with Spinal Cord Injury: A Systematic Review

2021 ◽  
Vol 18 (18) ◽  
pp. 9517
Author(s):  
Isabel Sinovas-Alonso ◽  
Ángel Gil-Agudo ◽  
Roberto Cano-de-la-Cuerda ◽  
Antonio J. del-Ama
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Outcome Measures ◽  
Berg Balance Scale ◽  
Walking Ability ◽  
Walk Test ◽  
Timed Up And Go ◽  
Cord Injury ◽  
Profile Score

Walking function recovery in spinal cord injury (SCI) is tackled through several therapeutic approaches in which precise evaluation is essential. A systematic review was performed to provide an updated qualitative review of walking ability outcome measures in SCI and to analyze their psychometric properties. PubMed, Cochrane, and PEDro databases were consulted until 1 April 2020. Seventeen articles written in English were included. Five of them studied the walking index for SCI, four studied the 10 meter walk test, and two studied the six-minute walk test, the timed Up and go test, and the Berg balance scale. The rest of the articles studied the following metrics: gait profile score, spinal cord injury functional ambulation profile, five times sit-to-stand test, spinal cord injury functional ambulation inventory, spinal cord independence measure (indoors and outdoors mobility items), locomotor stages in spinal cord injury, community balance and mobility scale, and activity-based balance level evaluation scale. The choice of a single or a set of metrics should be determined by the clinician. Based on the results obtained in this review, a combination of outcome measures is proposed to assess walking ability. Future work is required to integrate a more realistic environment for walking assessment.

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