🦀 PT Crab Issue 70 - Upright No.
This week, we find out the Upright Go may not be the best thing for people with PD (though it’s not useless either) and that backward walking reserve speed isn’t the best measure of fall risk. Our King Crab supporters (thanks all!) got two extra articles this week, like every week. One on what it’s like to have a hip replacement as a Physio (they’re British and thus use the better term) and a second, fantastic paper about what tools you should use to assess post-stroke balance. This week it’s half negative, half positive, and all crabby.
Also this week, Happy Thanksgiving! to our American readers. And Happy Thanksgiving! to everyone else too while we’re at it.
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With that, let’s dive in!
Upright No for Parkinson’s Walking. But Sitting is Go.
The Gist - These researchers publishing in Gait and Posture dug into the effects of the Upright Go on people with moderate PD (UPDRS III: 38.5) and found some good effects and some bad ones. We’ll start good. It immediately improved neck posture in both single and dual-task environments in sitting and standing. Yay! And the benefit carried over to the 7 day span the patients spent with the device at home. Also yay! And the bad news: gait worsened with the Upright Go. Boo! Single-task stride length, dual-task gait speed, and double support time were all significantly worse with the Upright Go. Balance was the same before and after.
To figure this all out, they placed the Upright Go on people and had them perform motor tasks “1) Sitting on a high-stool with no back with eyes open, 2) standing, feet at 10 cm apart, eyes open, looking at a poster painting, and 3) walking at comfortable speed (back and forth over 10m). Each task was 2-minutes long and repeated under single and dual-task.” They did all this while tracking metrics from multiple IMUs (inertial measurement units. Accelerometers strapped on to see what’s happenin’). They also trained the folks on how to use the device and app. After doing all this, they sent them home to use it for 7 days.
Tell Me More - If you don’t know the Upright Go, it’s a small device that either sticks or hangs on a necklace between the shoulder blades to measure posture and cue it to be better with a small vibration. It also has an app that does balance training and whatnot. I really like it because I have terrible posture and it’s quite helpful. If you’re interested, they’re at UprightPose.com and they partner with professionals (e.g. sell them cheaply to you) as well.
For this particular group, posture was indeed better, and that’s what Upright does well. But why was gait worse? Well, you’ve entered speculation territory, but it’s well-founded speculation at least. The researcher speculate that the hunched posture common to those with Parkinson’s is a compensatory posture to protect them from backwards instability. So straightening them up would lower gait confidence, hence shorter steps and lower speeds. The researchers also speculate that the vibrations from the Upright Go added an extra distraction to the gait tasks, making the participants worse at them.
Lastly, this is all about the short-term/immediate effects of the Upright Go, we don’t yet know if these effects hang around.
Paper? Sure thing boss.
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Backward Walking Speed Reserve to Predict Falls? No.
The Gist - This paper from the Canadian Journal of Physiotherapy was brief and looked into whether backward walking speed reserve could predict falls better than forward walking speed. It turns out that it doesn’t, but let’s hit the details anyway. It’s quite interesting. First off, backward walking speed reserve is the difference between maximal walking speed and self-selected walking speed, so they got these by measuring both across a GaitRite measurement device. The participants were half healthy older people and half older adults who have been identified as a fall risk, all without assistive devices.
Basically, the math they did was compare the reserve speeds between the two groups to see if there was a trend that stood out between the fall risk and the not fall risk folks. Unfortunately for their hypothesis, there was not. Rather, they reconfirmed that self-selected walking speed is the best predictor we have right now.
Tell Me More - The only more left in this short, four page study is some interesting detail about muscles and whatnot from the end. So I’m going to block quote it a bit here
It has been shown that during backward walking in young adults, the ankle joint primarily contributes to propulsion and shock absorption rather than the knee and hip joints. Whether this is true for older adults needs to be examined. Older adults have been shown to have altered joint mechanics, with increased use of hip extensors and reduced use of plantar flexors during forward walking compared with younger adults. Future studies should assess whether these altered mechanics or reduced strength among older adults contributes to their inability to increase backward maximal walking speed.
And that’s all she (okay, they) wrote.
Paper? Oh, Canada yet again.
And that’s our week!
Also, don't forget that we still have a sweet deal going on with Bright Cellars, check them out for 50% off your first box of 6 wines. That's a sweet $45 off. Yowza! Check them out here and support PT Crab in the process, just by clicking that link. Who are they? Oh just some Ivy League graduates who have an algorithm to choose wines you'll love. Yea, they're very cool. So grab some and fall in love.
Once again, if you like what I do at PT Crab, please consider becoming a King Crab supporter to help us along. It’s just $8 per month right now with our sale. And if you’re a student and that’s too steep for you, lmk via email (Luke@PTCrab.org) and we’ll work something out.
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Here are the articles we covered this week:
Stuart, S., Godfrey, A., & Mancini, M. (2022). Staying UpRight in Parkinson’s disease: A pilot study of a novel wearable postural intervention. Gait & Posture, 91, 86–93. https://doi.org/10.1016/j.gaitpost.2021.09.202
Yada, T. T., Taulbee, L., Balasubramanian, C., Freund, J., & Vallabhajosula, S. (2021). Can Backward Walking Speed Reserve Discriminate Older Adults at High Fall Risk? Physiotherapy Canada, 73(4), 353–357. https://doi.org/10.3138/ptc-2019-0086
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